Provider Demographics
NPI:1144264953
Name:IBIKUNLE, JIMMY O (MD)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:O
Last Name:IBIKUNLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2078 BERNAYS DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-1493
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2078 BERNAYS DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-1493
Practice Address - Country:US
Practice Address - Phone:717-764-2358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD073822L2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1448330OtherPA BLUE SHIELD
PA2103603OtherMAMSI
PA478844OtherVALUE OPTIONS
PA50008800OtherCAPITAL BLUE CROSS
PA001880921Medicaid
PA618995OtherBC/BS OF MD CARE FIRST
PA2088368OtherCIGNA BEHAVIORAL HEALTH
PA284716000OtherMAGELLAN
PA478844OtherVALUE OPTIONS
PA067378Medicare PIN