Provider Demographics
NPI:1316990864
Name:SENU-OKE, EDWARD OLUBANKOLE (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:OLUBANKOLE
Last Name:SENU-OKE
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:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:820 PRUDENTIAL DR STE 304
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8205
Practice Address - Country:US
Practice Address - Phone:904-202-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241450207R00000X
VAME124895208M00000X
FLME124895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1017159OtherOPTIMA HEALTH
VA1316990864OtherVIRGINIA PREMIER HEALTH PLAN
NC1316990864Medicaid
VAPAROtherVIRGINIA HEALTH NETWORK
VA1316990864OtherCOVENTRY NETWORK
VA1316990864OtherUNITED HEALTHCARE
VA490717OtherANTHEM BC/BS
VAPAROtherCIGNA
VA-028OtherTRICARE/CHAMPUS
VAPAROtherCORVEL
VAPAROtherMULTIPLAN
VAPAROtherAETNA
VAPAROtherUSA MANAGED CARE
VA1316990864Medicaid
VA-028OtherTRICARE/CHAMPUS
VA1316990864OtherUNITED HEALTHCARE
VA1316990864Medicaid