Provider Demographics
NPI:1144917105
Name:OLOWOYO, OLAMIDE
Entity type:Individual
Prefix:
First Name:OLAMIDE
Middle Name:
Last Name:OLOWOYO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:OLAMIDE
Other - Middle Name:OLUTOSIN
Other - Last Name:OYEKUNLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6393
Mailing Address - Fax:570-271-5623
Practice Address - Street 1:100 N ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-9800
Practice Address - Country:US
Practice Address - Phone:570-271-6393
Practice Address - Fax:570-271-5623
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD488760207RN0300X
PAMT228158207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology