Provider Demographics
NPI:1386806636
Name:OMIJE, OYINDAMOLA ABIMBOLA (MD)
Entity type:Individual
Prefix:
First Name:OYINDAMOLA
Middle Name:ABIMBOLA
Last Name:OMIJE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OYINDAMOLA
Other - Middle Name:ABIMBOLA
Other - Last Name:AMAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:283 S BUTLER RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-8939
Practice Address - Country:US
Practice Address - Phone:717-273-8871
Practice Address - Fax:717-270-2429
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4478482084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD447848OtherSTATE LICENSE
PA102872758Medicaid