MEDICARE: OLABODE O OGIDAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	25MA06442400	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1000203000	OTHER	AMERICHOICE
2	2699163	OTHER	GROUP HEALTH INC
3	564156	OTHER	AETNA HMO
4	17658	OTHER	UNIVERSITY HEALTH CARE
5	1K7910	OTHER	PHYSICIANS HEALTH
6	1043195	OTHER	HORIZON NJ HEALTH
7	J5528	OTHER	BLUE SHIELD NJ HMO
8	NJ1019	OTHER	BLUE SHIELD OF DELAWARE
9	5147093	OTHER	AETNA MANAGED CARE
10	1744624	OTHER	UNITED HEALTH CARE
11	989964000	OTHER	AMERIHEALTH
12	P402900	OTHER	OXFORD HEALTH PLANS
13	1325524	OTHER	CIGNA
14	4131512	OTHER	CIGNA
15	559261	OTHER	BLUE SHIELD OF NEW YORK E
16	6976409	OTHER	AMERIGROUP
17	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
18	1325524	OTHER	FIRST HEALTH GROUP CORP

General Provider Information

NPI Number	:	1124096383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLABODE O OGIDAN MD

Provider Business Mailing Address
First Line	:	1138 E CHESTNUT AVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08360-5053
Country	:	US
Telephone Number	:	856-692-1108
Fax Number	:	856-692-2077

Provider Business Practice Location Address
First Line	:	1138 E CHESTNUT AVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08360-5053
Country	:	US
Telephone Number	:	856-692-1108
Fax Number	:	856-692-2077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	03/25/2025

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Directions to “ OLABODE O OGIDAN MD” Practice Location

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