MEDICARE: ADEDAYO ODUWOLE

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	390200000X	Student in an Organized Health Care Education/Training Program		NY
2	2085R0202X	Diagnostic Radiology Physician	317134	NY
3	2085R0202X	Diagnostic Radiology Physician	MD484619	PA

General Provider Information

NPI Number	:	1417419144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEDAYO ODUWOLE

Provider Business Mailing Address
First Line	:	3400 CIVIC CENTER BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5127
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 CIVIC CENTER BLVD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5127
Country	:	US
Telephone Number	:	215-662-3264
Fax Number	:

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

Provider Enumeration Date	:	04/02/2019
Last Update Date	:	02/10/2026

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Directions to “ ADEDAYO ODUWOLE ” Practice Location

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