MEDICARE: DR. OLUTOYIN OLUGBENGA FAYEMI M.D.

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	207419	MA

General Provider Information

NPI Number	:	1396780011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OLUTOYIN OLUGBENGA FAYEMI M.D.

Provider Business Mailing Address
First Line	:	8 HAMPSHIRE ST
Second Line	:
City	:	EVERETT
State	:	MA
Zip	:	02149-3702
Country	:	US
Telephone Number	:	617-389-1846
Fax Number	:	441-236-8338

Provider Business Practice Location Address
First Line	:	695 TRUMAN PKWY
Second Line	:
City	:	HYDE PARK
State	:	MA
Zip	:	02136-3552
Country	:	US
Telephone Number	:	617-361-1470
Fax Number	:	617-361-9060

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	09/07/2007

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