Provider Demographics
NPI:1780809350
Name:ADEBAJO, FEYISITAN ADEKUNLE (MD)
Entity type:Individual
Prefix:
First Name:FEYISITAN
Middle Name:ADEKUNLE
Last Name:ADEBAJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-371-0373
Mailing Address - Fax:814-377-0359
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-375-6560
Practice Address - Fax:814-372-2848
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH79491Medicare UPIN