Provider Demographics
NPI:1861020026
Name:OENICK, OMOYEMI IDOWU (DO)
Entity type:Individual
Prefix:
First Name:OMOYEMI
Middle Name:IDOWU
Last Name:OENICK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:OMOYEMI
Other - Middle Name:AJOKE
Other - Last Name:IDOWU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3636 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3236
Mailing Address - Country:US
Mailing Address - Phone:757-398-2285
Mailing Address - Fax:757-397-5368
Practice Address - Street 1:3636 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3236
Practice Address - Country:US
Practice Address - Phone:757-398-2285
Practice Address - Fax:757-397-5368
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102207598208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist