Individual
OLUMIDE O AJAYEOBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 N ACADEMY AVE, DANVILLE, PA 17822-0001
(570) 271-6439
(570) 271-6852
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
(570) 271-6578
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD467704
PA
208M00000X
Hospitalist Physician
2014-01431
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144577826
TRICARE
NC
05
—
1144577826
—
NC
01
—
1869M
BCBS
NC
01
—
P01374327
RAILROAD MEDICARE
NC
Enumeration date
08/13/2012
Last updated
08/27/2020
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