Basic Information
| Provider Information | |||||||||
| NPI: | 1790211365 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OBADINA | ||||||||
| FirstName: | MOFIYINFOLUWA | ||||||||
| MiddleName: | AYOMIKUN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 406 SUBURBAN CT APT 3 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146203832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404811128 | ||||||||
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| Practice Location | |||||||||
| Address1: | 170 MANNING DRIVE CB#7305 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199661996 | ||||||||
| FaxNumber: | 9199666735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2017 | ||||||||
| LastUpdateDate: | 04/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 302939 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 302939 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.