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Contact Information

EGEDE J AITSEBAOMO, MD
1 GUTHRIE SQ
SAYRE, PA18840-1625
 Phone: 570-887-2289
 Fax: 570-887-2290
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Cardiovascular Disease

207RC0000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for EGEDE J AITSEBAOMO · (Male)

NPI Number 1376620682
Status Active
Credentials MD
Entity Individual
Enumeration date 11/01/2006
Last updated 03/14/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 285781
  • PA License # MD459847
  • NC Medicaid 8913023
Hospital affiliation(s)
  • CORNING HOSPITAL - (Acute Care)
    176 DENISON PARKWAY EAST
    CORNING, NY 14830
  • ROBERT PACKER HOSPITAL - (Acute Care)
    ONE GUTHRIE SQUARE
    SAYRE, PA 18840
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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