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General NPI Number Information
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NPI Number | 1699889154
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Entity Type | Organization
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Legal Business Name | SUBURBAN INTERNAL MEDICINE ASSOCIATES, PA
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1403 N RODNEY ST
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City | WILMINGTON
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State | DE
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Zip | 19806-4218
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Country | US
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Telephone | 302-654-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 1403 N RODNEY ST
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City | WILMINGTON
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State | DE
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Zip | 19806-4218
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Country | US
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Telephone | 302-654-4800
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OMO OLURIN
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Credential | MD
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Telephone | 302-654-4800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2002107036
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License Number State | DE
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