Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 25MB09317300 | NJ |
Y | 207QS0010X | Family Doctor - Sports Medicine | OS016482 | PA |
NPI | 1336451590 |
---|---|
Provider Name | Oluseun Olumide Wert |
First Address | Pittsburgh, PA 15227-2720 |
Second Address | Pittsburgh, PA 15227-2720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2010 |
Last Update Date | 08/06/2015 |