Provider Demographics
NPI:1861197154
Name:ADETOLA, ADEBISI
Entity type:Individual
Prefix:
First Name:ADEBISI
Middle Name:
Last Name:ADETOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 KENNEDY ST NW UNIT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3137
Mailing Address - Country:US
Mailing Address - Phone:202-223-9630
Mailing Address - Fax:
Practice Address - Street 1:16008 PENNSBURY DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1900
Practice Address - Country:US
Practice Address - Phone:301-257-6745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management