Basic Information
| Provider Information | |||||||||
| NPI: | 1255754198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAOYE | ||||||||
| FirstName: | ABIODUN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190133955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106198590 | ||||||||
| FaxNumber: | 6106198591 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190133955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106198590 | ||||||||
| FaxNumber: | 6106198591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2014 | ||||||||
| LastUpdateDate: | 12/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 90292 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | MD453752 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.