Provider Demographics
NPI:1003918582
Name:ADEPOJU, ADEYINKA A (PT)
Entity Type:Individual
Prefix:
First Name:ADEYINKA
Middle Name:A
Last Name:ADEPOJU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6738 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4122
Mailing Address - Country:US
Mailing Address - Phone:410-499-5216
Mailing Address - Fax:410-944-8751
Practice Address - Street 1:6738 DOGWOOD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4122
Practice Address - Country:US
Practice Address - Phone:410-499-5216
Practice Address - Fax:410-944-8751
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD207P466GMedicare PIN