Basic Information
| Provider Information | |||||||||
| NPI: | 1730117961 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAMUYIWA | ||||||||
| FirstName: | OLUFUNSHO | ||||||||
| MiddleName: | OLADELE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 MOUNT ROSE AVE | ||||||||
| Address2: | SUITE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178516969 | ||||||||
| Practice Location | |||||||||
| Address1: | 292 SAINT CHARLES WAY | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178516231 | ||||||||
| FaxNumber: | 7178515978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 01/08/2010 | ||||||||
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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 | 207RE0101X | MD419550 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 03253001 | 01 | PA | CAPITAL BLUE CROSS-WMG | OTHER | 104612 | 01 | PA | JOHNS HOPKINS | OTHER | 136309 | 01 | PA | UNISON-WMG | OTHER | 1404335 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 1530147 | 01 | PA | GATEWAY-WMG | OTHER | 367128 | 01 | PA | MAMSI-WMG | OTHER | 20017690 | 01 | PA | AMERIHEALTH MERCY-WMG | OTHER | 83883 | 01 | PA | GEISINGER | OTHER | 001902831 | 05 | PA | MEDICAID | 615820 | 01 | MD | CAREFIRST MD BCBS | OTHER | 7673463 | 01 | PA | AETNA | OTHER |