DR. OLUTAYO TEMITOPE IMEVBORE M.D. NPI 1750447421

NPI Information

NPI: 1750447421
Provider Name: DR. OLUTAYO TEMITOPE IMEVBORE, M.D.
Classification: Hospitalist - 208M00000X
Entity Type: Individual
Organization: NORTHEAST MEDICAL GROUP INC

PECOS Registration: Yes

Address:
20 YORK ST # CB-2041
NEW HAVEN, CT
ZIP 06504
Phone: (203) 688-4748
Get Directions

DR. Olutayo Temitope Imevbore, M.D. is a hospitalist in New Haven, CT with 29 years of experience. The provider is hospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients. DR. Olutayo Temitope Imevbore, M.D. NPI is 1750447421. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

20 YORK ST # CB-2041
NEW HAVEN, CT
ZIP 06504-900
Phone: (203) 688-4748

The NPI 1750447421 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 12/28/2006 and was last updated on 7/16/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208M00000X	Hospitalist		042354	CONNECTICUT	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	BI8890419	OTHER	CONNECTICUT	FED DEA REGISTRATION
2	35237	OTHER	CONNECTICUT	CT CSR
3	042354	OTHER	CONNECTICUT	CT PHYSICIAN LICENSE
4	110009278	MEDICARE ID-TYPE UNSPECIFIED	CONNECTICUT	PROVIDER NUMBER
5	001423540	MEDICAID	CONNECTICUT
6	I11883	MEDICARE UPIN	CONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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