Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 13694 | FL |
N | 111NI0900X | Internist | 13694 | FL |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD465107 | PA |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | ME119257 | FL |
NPI | 1093940918 |
---|---|
Provider Name | Omodele Ibitola Hogan |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-5301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2009 |
Last Update Date | 28/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013079700 | (05) | FL |