Provider Demographics
NPI:1861063547
Name:PLUMPTRE, ADEWALE (MD)
Entity type:Individual
Prefix:DR
First Name:ADEWALE
Middle Name:
Last Name:PLUMPTRE
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 1:1407 LINDEN BLVD APT 13J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5114
Mailing Address - Country:US
Mailing Address - Phone:347-471-3338
Mailing Address - Fax:
Practice Address - Street 1:305 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:NY
Practice Address - Zip Code:11769-1652
Practice Address - Country:US
Practice Address - Phone:631-218-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP109660207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine