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General NPI Number Information
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NPI Number | 1659552156
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Entity Type | Organization
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Legal Business Name | OLUMUYIWA OJEDIRAN, M.D P.C
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | 734 S SYCAMORE ST
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City | PETERSBURG
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State | VA
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Zip | 23803-5817
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Country | US
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Telephone | 804-733-0111
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Fax | 804-733-1176
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Provider Business Mailing Address
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Address Line | 734 S SYCAMORE ST
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City | PETERSBURG
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State | VA
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Zip | 23803-5817
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Country | US
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Telephone | 804-733-0111
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Fax | 804-733-1176
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OLUMUYIWA AKINNIYI OJEDIRAN
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Credential | M.D
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Telephone | 804-733-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number | 0101233648
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License Number State | VA
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