Provider Demographics
NPI:1043727217
Name:ADERETI, ADEBOLA
Entity Type:Individual
Prefix:
First Name:ADEBOLA
Middle Name:
Last Name:ADERETI
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 1:19 CHAPMANVIEW CT
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-3503
Mailing Address - Country:US
Mailing Address - Phone:240-603-0890
Mailing Address - Fax:
Practice Address - Street 1:19 CHAPMANVIEW CT
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-3503
Practice Address - Country:US
Practice Address - Phone:240-603-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000000000Medicaid
MD0000000000Medicaid