Provider Demographics
NPI:1033372891
Name:ADEWUSI, ADEBIMPE OLUBUSAYO (MD)
Entity Type:Individual
Prefix:
First Name:ADEBIMPE
Middle Name:OLUBUSAYO
Last Name:ADEWUSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:PORTER 005
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-444-2877
Mailing Address - Fax:401-444-3804
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:PORTER 005
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-2877
Practice Address - Fax:401-444-3804
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD442550208000000X, 282NC0060X
PAMT193447208000000X
RIMD145482080C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access