MEDICARE: DR. IDITH OBEHI OJO CRNP

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	363LF0000X	Family Nurse Practitioner	SP017405	PA

General Provider Information

NPI Number	:	1780105247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IDITH OBEHI OJO CRNP

Provider Business Mailing Address
First Line	:	501 S 54TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19143-1900
Country	:	US
Telephone Number	:	215-748-9707
Fax Number	:

Provider Business Practice Location Address
First Line	:	7439 FRANKFORD AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19136-3600
Country	:	US
Telephone Number	:	215-821-7336
Fax Number	:	215-827-5585

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

Provider Enumeration Date	:	07/05/2017
Last Update Date	:	02/11/2019

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