Basic Information
| Provider Information | |||||||||
| NPI: | 1942430988 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IDONIBOYE | ||||||||
| FirstName: | LOLIYA | ||||||||
| MiddleName: | FAUSTINA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 LEHIGH ST | ||||||||
| Address2: | OFFICE OF MEDICAL EDUCATION | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181033880 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1510 COLUMBUS AVE STE 230 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON COURT HOUSE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431601987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403332243 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2009 | ||||||||
| LastUpdateDate: | 05/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OT013312 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0184846 | 05 | OH | MEDICAID |