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General NPI Number Information
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NPI Number | 1306041652
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Entity Type | Individual
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Provider Name | OLUTOYIN MODUPE MALOMO MD
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 07/15/2009
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Provider Practice Location Address
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Address Line | 1800 ENGLISH RD SUITE 10
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City | ROCHESTER
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State | NY
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Zip | 14616-1691
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Country | US
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Telephone | 585-225-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 ELMWOOD AVE APT 7
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City | ROCHESTER
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State | NY
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Zip | 14620-3862
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Country | US
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Telephone | 585-672-1322
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 253647-1
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License Number State | NY
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