Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 227766 | MA |
NPI | 1669544169 |
---|---|
Provider Name | Abidemi Adetoyese Adegbola |
First Address | Philadelphia, PA 19107-5127 |
Second Address | Philadelphia, PA 19131-2824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 17/06/2021 |