1871759480 NPI number — DR. TOLULOPE KOFI AKINYEMI M.D.

Table of content: (NPI 1184918302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871759480 NPI number — DR. TOLULOPE KOFI AKINYEMI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AKINYEMI
Provider First Name:
TOLULOPE
Provider Middle Name:
KOFI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AKINYEMI
Provider Other First Name:
TOLU
Provider Other Middle Name:
KOFI
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1871759480
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 GRIFFIN RD
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03801-7145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-610-4430
Provider Business Mailing Address Fax Number:
603-610-4432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 GRIFFIN RD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03801-7145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-610-4430
Provider Business Practice Location Address Fax Number:
603-610-4432
Provider Enumeration Date:
08/03/2008

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: 2086S0129X , with the licence number:  MD441385 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: LT-3628 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102742655 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2719120 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1610609 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 055948200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30126260 . This is a "AMERIHEALTH MERCY - WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com