Basic Information
| Provider Information | |||||||||
| NPI: | 1164558763 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AYOOLA | ||||||||
| FirstName: | AYODELE | ||||||||
| MiddleName: | GANIYU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 858 | ||||||||
| Address2: | MC A410 | ||||||||
| City: | HERSHEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170330858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002431455 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 500 UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | HERSHEY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170332360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002431455 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 09/21/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD434146 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2503756 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 30084758 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 1024562890002 | 05 | PA | MEDICAID | 416249 | 01 | PA | UPMC-WMG | OTHER | 905540 | 01 | MD | CAREFIRST MD BCBS-WMG | OTHER | 014222101 | 05 | MD | MEDICAID | 1582969 | 01 | PA | GATEWAY-WMG | OTHER | 394320 | 01 | PA | UNISON-WMG | OTHER |