Provider Demographics
NPI:1447067889
Name:OSOBAJO, SILAS
Entity type:Individual
Prefix:
First Name:SILAS
Middle Name:
Last Name:OSOBAJO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BUCKLIN ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02861-1902
Mailing Address - Country:US
Mailing Address - Phone:401-572-6295
Mailing Address - Fax:401-223-6309
Practice Address - Street 1:80 BUCKLIN ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861-1902
Practice Address - Country:US
Practice Address - Phone:401-572-6295
Practice Address - Fax:401-223-6309
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)