Individual provider Active NPI

Samuel Opeoluwa Kolawole, MD

  • Internal Medicine Physician
  • Easton, PA
National Provider Identifier
1720929102
Registry record updated May 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MT237319 Issued in PA
Practice address
1700 St Lukes Blvd
Easton, PA 18045-5670
Phone
(484) 526-1000
NPI assigned
Apr 2, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2026

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 MT237319 PA Primary

Addresses

Primary practice location

1700 St Lukes Blvd
Easton, PA 18045-5670

Mailing address

1700 St Lukes Blvd
Easton, PA 18045-5670
Phone (484) 526-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260602002349 PA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 7113498072

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MT237319PAMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1775088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779321600000",
    "number": "1720929102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 ST LUKES BLVD",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180455670",
            "telephone_number": "484-526-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 ST LUKES BLVD",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180455670",
            "telephone_number": "484-526-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLAWOLE",
        "first_name": "SAMUEL",
        "middle_name": "OPEOLUWA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-04-02",
        "last_updated": "2026-05-21",
        "certification_date": "2026-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT237319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Easton, PA

Sources for this page

Verify at the official NPI Registry.