Provider Demographics
NPI:1518701689
Name:OGUNDIPE, TAIWO IBUKUN (MD)
Entity type:Individual
Prefix:
First Name:TAIWO
Middle Name:IBUKUN
Last Name:OGUNDIPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18921 TIOGA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3016
Mailing Address - Country:US
Mailing Address - Phone:240-825-8363
Mailing Address - Fax:
Practice Address - Street 1:1050 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1618
Practice Address - Country:US
Practice Address - Phone:516-374-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP128808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine