1689834269 NPI number — DR. YETUNDE ADEOLA ADESANYA M.D

Table of content: DR. YETUNDE ADEOLA ADESANYA M.D (NPI 1689834269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689834269 NPI number — DR. YETUNDE ADEOLA ADESANYA M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADESANYA
Provider First Name:
YETUNDE
Provider Middle Name:
ADEOLA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689834269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 647
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPE MILLS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28348-0647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-483-7337
Provider Business Mailing Address Fax Number:
910-483-0648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3115 BORDEAUX PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28306-2894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-307-7337
Provider Business Practice Location Address Fax Number:
910-323-4620
Provider Enumeration Date:
06/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  2008-00941 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1045067 . This is a "WELLPATH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 217771 . This is a "MEDCOST, LLC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: FH1101555 . This is a "FIRST CAROLINA CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1689834269 . This is a "HEALTHNET FEDERAL SERVICES" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4015906 . This is a "COVENTRY NATIONAL - COVENTRY PPO" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 12735847 . This is a "PHCS-MULTIPLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1689834269 . This is a "DOCTORS DIRECT" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1689834269 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9297402 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1045067 . This is a "COVENTRY OF THE CAROLINAS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1689834269 . This is a "HUMANA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3038401 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4101857 . This is a "CIGNA GREATWEST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1603J . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1689834269 . This is a "HEALTHSMART" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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