Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 01264 | MD |
NPI | 1487638854 |
---|---|
Provider Name | Dr. Ademuyiwa Adekola Adetunji |
First Address | Fulton, MD 20759-0265 |
Second Address | Upper Marlboro, MD 20774-5376 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 10/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
319906101 | (05) | MD |
U71263 | (02) | MD |