Provider Demographics
NPI:1871353557
Name:OTOMEWO, ISAAC (MD)
Entity type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:
Last Name:OTOMEWO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2813 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:MIFFLINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17059-9078
Mailing Address - Country:US
Mailing Address - Phone:717-436-8283
Mailing Address - Fax:717-436-8351
Practice Address - Street 1:400 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1167
Practice Address - Country:US
Practice Address - Phone:717-242-7507
Practice Address - Fax:717-242-7593
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-04-15
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Provider Licenses
StateLicense IDTaxonomies
PAMT230680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine