Provider Demographics
NPI:1548265168
Name:OLURIN, OMOWUMI O (MD)
Entity type:Individual
Prefix:DR
First Name:OMOWUMI
Middle Name:O
Last Name:OLURIN
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 1:1403 N RODNEY ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4218
Mailing Address - Country:US
Mailing Address - Phone:302-654-4800
Mailing Address - Fax:302-984-0440
Practice Address - Street 1:1403 N RODNEY ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4218
Practice Address - Country:US
Practice Address - Phone:302-654-4800
Practice Address - Fax:302-984-0440
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1005174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000833001Medicaid
DE0000833001Medicaid
00B161567Medicare ID - Type UnspecifiedINDIVIDUAL
G00867Medicare ID - Type UnspecifiedGROUP