Basic Information
Provider Information
NPI: 1003800053
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DAWODU
FirstName: SEGUN
MiddleName: TOYIN
NamePrefix: DR.
NameSuffix:  
Credential: MD, JD, MBA, LLM, MS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3421 CONCORD RD
Address2:  
City: YORK
State: PA
PostalCode: 174029001
CountryCode: US
TelephoneNumber: 7173392790
FaxNumber: 7173392771
Practice Location
Address1: 40 V TWIN DR
Address2: SUITE 205
City: GETTYSBURG
State: PA
PostalCode: 173257875
CountryCode: US
TelephoneNumber: 7173392790
FaxNumber: 7173392771
Other Information
ProviderEnumerationDate: 09/06/2005
LastUpdateDate: 06/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000XMD071276LPAN Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 
208100000XD56237MDN Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 
2081P0004XD56237MDN Allopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
2081P2900XMD071276LPAY Allopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
2081P2900X0101227545VAN Allopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
2081P2900XD56237MDN Allopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
2081S0010XMD071276LPAN Allopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
2081S0010XD56237MDN Allopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
208VP0014XD56237MDN Allopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine

ID Information
IDTypeStateIssuerDescription
F21601MDBCBSOTHER
69963110005MD MEDICAID
67512780-0101MDCIGNAOTHER
776718701MDAETNAOTHER
10252401VAANTHEM BCBSOTHER
10299645005PA MEDICAID


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