Provider Demographics
NPI:1235401787
Name:ADELEKUN, ADEKOLA DAMILARE
Entity Type:Individual
Prefix:
First Name:ADEKOLA
Middle Name:DAMILARE
Last Name:ADELEKUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10702 WEEPING WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3820
Mailing Address - Country:US
Mailing Address - Phone:301-256-1308
Mailing Address - Fax:301-256-1308
Practice Address - Street 1:10702 WEEPING WILLOW LN
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3820
Practice Address - Country:US
Practice Address - Phone:301-256-1308
Practice Address - Fax:301-256-1308
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide