Provider Demographics
NPI:1225687429
Name:ISAIAH-BOJOMIMO, OLUWAKEMI DOLAPO (MD)
Entity type:Individual
Prefix:
First Name:OLUWAKEMI
Middle Name:DOLAPO
Last Name:ISAIAH-BOJOMIMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLUWAKEMI
Other - Middle Name:DOLAPO
Other - Last Name:ISAIAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 NEAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:MARION CENTER
Mailing Address - State:PA
Mailing Address - Zip Code:15759
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 NEAL AVENUE
Practice Address - Street 2:
Practice Address - City:MARION CENTER
Practice Address - State:PA
Practice Address - Zip Code:15759
Practice Address - Country:US
Practice Address - Phone:724-397-5571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH010684796Medicaid