1801089123 NPI number — MR. FELIX A ADEYEMI PHYSICIAN ASSISSTANT

Table of content: MR. FELIX A ADEYEMI PHYSICIAN ASSISSTANT (NPI 1801089123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801089123 NPI number — MR. FELIX A ADEYEMI PHYSICIAN ASSISSTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADEYEMI
Provider First Name:
FELIX
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISSTANT
Provider Gender Code:
M

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:
1801089123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11744 PINDELL CHASE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FULTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20759-9704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-776-2501
Provider Business Mailing Address Fax Number:
301-776-3150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11744 PINDELL CHASE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20759-9704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-776-2501
Provider Business Practice Location Address Fax Number:
301-776-3150
Provider Enumeration Date:
08/21/2007

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: 363A00000X , with the licence number:  C0003585 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C0003585 . This is a "MBP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: PA66622 . This is a "CDS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1077284 . This is a "NCCPA" identifier . This identifiers is of the category "OTHER".




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