Provider Demographics
NPI:1245448000
Name:FAYOMI, GABRIEL ADEREMI (PA-C)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:ADEREMI
Last Name:FAYOMI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11000 ELON DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3507
Mailing Address - Country:US
Mailing Address - Phone:301-352-0308
Mailing Address - Fax:
Practice Address - Street 1:920 VARNUM ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2145
Practice Address - Country:US
Practice Address - Phone:202-269-7400
Practice Address - Fax:202-269-7823
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant