Provider Demographics
NPI:1174621809
Name:ADENIYI, OLATOKUNBO MADUPE (MD)
Entity type:Individual
Prefix:DR
First Name:OLATOKUNBO
Middle Name:MADUPE
Last Name:ADENIYI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:5125 JONESTOWN RD STE 105
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2987
Practice Address - Country:US
Practice Address - Phone:717-943-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.133438207R00000X, 208000000X
WV21580208000000X, 207R00000X
PAMD464185207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000897Medicaid
WVI13078Medicare UPIN
WV3810000897Medicaid
WV4176161Medicare PIN
WV7324481Medicare PIN