Provider Demographics
NPI:1124096383
Name:OGIDAN, OLABODE O (MD)
Entity type:Individual
Prefix:
First Name:OLABODE
Middle Name:O
Last Name:OGIDAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 E CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5053
Mailing Address - Country:US
Mailing Address - Phone:856-692-1108
Mailing Address - Fax:856-692-2077
Practice Address - Street 1:1138 E CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5053
Practice Address - Country:US
Practice Address - Phone:856-692-1108
Practice Address - Fax:856-692-2077
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06442400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1000203000OtherAMERICHOICE
2699163OtherGROUP HEALTH INC
564156OtherAETNA HMO
17658OtherUNIVERSITY HEALTH CARE
1K7910OtherPHYSICIANS HEALTH
1043195OtherHORIZON NJ HEALTH
J5528OtherBLUE SHIELD NJ HMO
NJ1019OtherBLUE SHIELD OF DELAWARE
5147093OtherAETNA MANAGED CARE
1744624OtherUNITED HEALTH CARE
989964000OtherAMERIHEALTH
P402900OtherOXFORD HEALTH PLANS
1325524OtherCIGNA
4131512OtherCIGNA
559261OtherBLUE SHIELD OF NEW YORK E
6976409OtherAMERIGROUP
NJ6976409Medicaid
1325524OtherFIRST HEALTH GROUP CORP
G18645Medicare UPIN