Provider Demographics
NPI:1174197040
Name:ABATAN, ADERONKE ABIMBOLA
Entity Type:Individual
Prefix:
First Name:ADERONKE
Middle Name:ABIMBOLA
Last Name:ABATAN
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 1:1952 PAWLET DR
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1687
Mailing Address - Country:US
Mailing Address - Phone:301-256-8987
Mailing Address - Fax:
Practice Address - Street 1:1952 PAWLET DR
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1687
Practice Address - Country:US
Practice Address - Phone:301-256-8987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-16
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAG4210049363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology