Provider Demographics
NPI:1053479204
Name:ADETU, TITILAYO OLUTOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:TITILAYO
Middle Name:OLUTOLA
Last Name:ADETU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TITILAYO
Other - Middle Name:O
Other - Last Name:ADETU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 7000
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20792-7000
Mailing Address - Country:US
Mailing Address - Phone:301-841-5666
Mailing Address - Fax:
Practice Address - Street 1:500 UPPER CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4324
Practice Address - Country:US
Practice Address - Phone:443-643-1000
Practice Address - Fax:904-805-1302
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046945207P00000X
VA0101054697207P00000X
AZ71617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD489PR148Medicare PIN
MDF98664Medicare UPIN