1003005661 NPI number — DR. ADEFOLAJU OKETOKUN MD

Table of content: DR. ADEFOLAJU OKETOKUN MD (NPI 1003005661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003005661 NPI number — DR. ADEFOLAJU OKETOKUN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OKETOKUN
Provider First Name:
ADEFOLAJU
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OLUFUWA
Provider Other First Name:
ADEFOLAJU
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003005661
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 91280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20090-1280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-636-5136
Provider Business Mailing Address Fax Number:
202-636-5137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1629 K STREET NW
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20006-1631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-636-1360
Provider Business Practice Location Address Fax Number:
202-636-5137
Provider Enumeration Date:
10/19/2007

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: 207RA0401X , with the licence number:  D0084292 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: C1-0008405 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RA0401X , with the licence number: MD038372 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: MD430487 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: MD 038372 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RA0401X , with the licence number: 0101262019 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QU0200X , with the licence number: MD 038372 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: MD038372 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 040597500 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".