| Olumuyiwa Ojediran, M.d P.c | |
|
734 S Sycamore St Petersburg VA 23803-5817 | |
| (804) 733-0111 | |
| (804) 733-1176 |
| Full Name | Olumuyiwa Ojediran, M.d P.c |
|---|---|
| Speciality | Internal Medicine |
| Location | 734 S Sycamore St, Petersburg, Virginia |
| Authorized Official Name and Position | Olumuyiwa Akinniyi Ojediran (PRESIDENT) |
| Authorized Official Contact | 8047330111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Olumuyiwa Ojediran, M.d P.c 734 S Sycamore St Petersburg VA 23803-5817 Ph: (804) 733-0111 | Olumuyiwa Ojediran, M.d P.c 734 S Sycamore St Petersburg VA 23803-5817 Ph: (804) 733-0111 |
| NPI Number | 1659552156 |
|---|---|
| Provider Enumeration Date | 11/26/2007 |
| Last Update Date | 11/26/2007 |
| Medicare PECOS PAC ID | 2163603085 |
|---|---|
| Medicare Enrollment ID | O20110225000421 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659552156 | NPI | - | NPPES |
| 465753 | Other | VA | BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RA0000X | Internal Medicine - Adolescent Medicine | 0101233648 (Virginia) | Primary |
| Provider Name | Olymuyiwa Akinniyi Ojediran |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1679594030 PECOS PAC ID: 0143401067 Enrollment ID: I20110225000439 |
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