Provider Demographics
NPI:1265864029
Name:FUJAH, ADEBOLA
Entity Type:Individual
Prefix:MISS
First Name:ADEBOLA
Middle Name:
Last Name:FUJAH
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 1:4615 HORIZON CIR APT 201
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2390
Mailing Address - Country:US
Mailing Address - Phone:443-557-8146
Mailing Address - Fax:
Practice Address - Street 1:4615 HORIZON CIR APT 201
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2390
Practice Address - Country:US
Practice Address - Phone:443-557-8146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-04
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT00664173747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant