Provider Demographics
NPI:1962663328
Name:OWOLABI, TIMOTHY TEMITOPE (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:TEMITOPE
Last Name:OWOLABI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 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 1:3106 PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-8938
Practice Address - Country:US
Practice Address - Phone:717-264-3644
Practice Address - Fax:717-264-9077
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37404207Q00000X
PAMD436726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102330222 0001Medicaid
PA251716306OtherINFORMED
PA283716OtherUNISON
PA9474363OtherAETNA NON-HMO
PA1962663328OtherFIRST HEALTH
PA25-1716306OtherDEVON
PA251716306OtherMAMSI
PAMD436726OtherLICENSE
PA2218823OtherMAMSI
PA1962663328OtherHEALTH AMERICA
PA867633OtherMEDICARE GROUP #
PAU947-0001OtherCAREFIRST DC
PA120420408OtherDEPT OF LABOR
PA251716306OtherSOUTH CENTRAL PREFERRED
PA251716306OtherHEALTHNET/TRICARE
PA6950335OtherAETNA HMO
PA251716306OtherDEVON HEALTH
PA955397-01OtherCAREFIRST MD
PA1007307260034OtherMEDICAID GROUP #
PA25-1716306OtherGREATWEST HEALTHCARE
PA25-1716306OtherMULTIPLAN/PHCS
PA50086441OtherCAPITAL BLUECROSS
PAP0010038OtherGATEWAY
PAP00746970OtherRAILROAD MEDICARE
PA25-1716306OtherINTERGROUP
PA434942OtherHIGHMARK BLUE SHIELD GROUP #
PAOW2128757OtherHIGHMARK BLUESHIELD
PAOW2128757OtherHIGHMARK BLUESHIELD
PAFO0512714OtherDEA