Basic Information
| Provider Information | |||||||||
| NPI: | 1366672982 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OMOSOLA | ||||||||
| FirstName: | AYOBAMI | ||||||||
| MiddleName: | OMOYEMI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 980509 | ||||||||
| Address2: | IM: INTERNAL MEDICINE | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232980509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048289726 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 417 N 11TH ST | ||||||||
| Address2: | IM RESIDENT ACC CLINIC | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232985002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048288786 | ||||||||
| FaxNumber: | 8048285466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2009 | ||||||||
| LastUpdateDate: | 07/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 0116020895 | VA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.