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Oluwole Olugbenga Jegede

Psychiatry & Neurology

Allopathic & Osteopathic Physicians

184 Front Ave, West Haven, CT 06516-2836

PECOS Enrollment

This provider is enrolled in PECOS as OLUWOLE JEGEDE.

Based on the most recent information from CMS, provider Oluwole Olugbenga Jegede is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1063717775
Provider Type
Individual
Full Name
Jegede, Oluwole Olugbenga
Title
Dr.
Credential
M.D

Gender
Male
Sole Proprietor
No
Enumeration Date
1/12/2011
Last Updated
1/24/2022

Contact Information

Practice Location

184 Front Ave, West Haven, CT 06516-2836

(203) 781-4600

(203) 781-4624

Mailing Location

1 Long Wharf Dr Ste 321, New Haven, CT 06511-5946

(203) 781-4600

(203) 781-4624

Provider Taxonomies

Code	Description	License
Code 2084P0800X Primary	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License 65093 Connecticut
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID 008068298	Description Medicaid	Issuer Unlisted Connecticut
ID 008068631	Description Medicaid	Issuer Unlisted Connecticut
ID 008095286	Description Medicaid	Issuer Unlisted Connecticut
ID 008068749	Description Medicaid	Issuer Unlisted Connecticut
ID 008068669	Description Medicaid	Issuer Unlisted Connecticut

Oluwole Olugbenga Jegede

PECOS Enrollment

Profile Details

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