Ayobami Omoyemi Omosola, MD

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

0116020895 Issued in VA

Practice address

417 N 11TH St
Im Resident Acc Clinic
Richmond, VA 23298-5002

Phone

(804) 828-8786

Fax

(804) 828-5466

NPI assigned

Jul 16, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279843200000",
    "number": "1366672982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 980509",
            "address_2": "IM: INTERNAL MEDICINE",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232980509",
            "telephone_number": "804-828-9726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 N 11TH ST",
            "address_2": "IM RESIDENT ACC CLINIC",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232985002",
            "telephone_number": "804-828-8786",
            "fax_number": "804-828-5466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMOSOLA",
        "first_name": "AYOBAMI",
        "middle_name": "OMOYEMI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-16",
        "last_updated": "2010-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "VA",
            "license": "0116020895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Student in an Organized Health Care Education/Training Program in Richmond, VA
• Providers in Richmond, VA by specialty
• Student in an Organized Health Care Education/Training Program in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.