Individual provider Active NPI

Omowumi O Olurin, M.D

  • Internal Medicine Physician
  • Wilmington, DE
National Provider Identifier
1548265168
Registry record updated Apr 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C1005174 Issued in DE
Practice address
1403 N Rodney St
Wilmington, DE 19806-4218
Phone
(302) 654-4800
Fax
(302) 984-0440
NPI assigned
Jun 20, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X C1005174 DE Primary

Addresses

Primary practice location

1403 N Rodney St
Wilmington, DE 19806-4218

Mailing address

1403 N Rodney St
Wilmington, DE 19806-4218
Phone (302) 654-4800

Other identifiers 1

IdentifierTypeStateIssuer
0000833001MedicaidDE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C1005174DEMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Suburban Internal Medicine Associates, PA Internal Medicine Past Accepting new patients
Pecos T. Olurin MD, PA Internal Medicine PastSince Apr 1, 1999 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209513600000",
    "number": "1548265168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1403 N RODNEY ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198064218",
            "telephone_number": "302-654-4800",
            "fax_number": "302-984-0440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1403 N RODNEY ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198064218",
            "telephone_number": "302-654-4800",
            "fax_number": "302-984-0440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLURIN",
        "first_name": "OMOWUMI",
        "middle_name": "O",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-20",
        "last_updated": "2008-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "DE",
            "license": "C1005174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000833001",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; 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.