Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | D56237 | MD |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | MD071276L | PA |
N | 2081P2900X | Pain Medicine | 0101227545 | VA |
N | 2081P2900X | Pain Medicine | D56237 | MD |
N | 2081P2900X | Pain Medicine | MD071276L | PA |
N | 2081S0010X | Sports Medicine | D56237 | MD |
N | 213ES0000X | Sports Medicine | D56237 | MD |
N | 2081S0010X | Sports Medicine | MD071276L | PA |
N | 213ES0000X | Sports Medicine | MD071276L | PA |
NPI | 1003800053 |
---|---|
Provider Name | Dr. Segun Toyin Dawodu |
First Address | York, PA 17402-9001 |
Second Address | Gettysburg, PA 17325-7875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2005 |
Last Update Date | 09/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102524 | ANTHEM BCBS (01) | VA |
102996450 | (05) | PA |
67512780-01 | CIGNA (01) | MD |
699631100 | (05) | MD |
7767187 | AETNA (01) | MD |
F216 | BCBS (01) | MD |
H24132 | (02) | MD |