Provider Demographics
NPI:1861821571
Name:FOLAGBADE, ABIMBOLA ADEYEMI
Entity type:Individual
Prefix:
First Name:ABIMBOLA
Middle Name:ADEYEMI
Last Name:FOLAGBADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7713 BENDER RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4130
Mailing Address - Country:US
Mailing Address - Phone:240-413-2057
Mailing Address - Fax:
Practice Address - Street 1:7713 BENDER RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4130
Practice Address - Country:US
Practice Address - Phone:240-413-2057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-03
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA9536374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide