1730136615 NPI number — AYODELE L ADEBAYO MD, MPH

Table of content: AYODELE L ADEBAYO MD, MPH (NPI 1730136615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730136615 NPI number — AYODELE L ADEBAYO MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADEBAYO
Provider First Name:
AYODELE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
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:
1730136615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6105 CENTER HILL AVE
Provider Second Line Business Mailing Address:
FE-A4
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45224-1705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-634-1622
Provider Business Mailing Address Fax Number:
513-386-1807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6105 CENTER HILL AVE
Provider Second Line Business Practice Location Address:
FE-A4
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45224-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-634-1622
Provider Business Practice Location Address Fax Number:
513-386-1807
Provider Enumeration Date:
05/27/2006

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: 207R00000X , with the licence number:  35084960 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2083X0100X , with the licence number: 35.084960 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2536018 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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