Provider Demographics
NPI:1275063893
Name:ADEJUMO, ADEYINKA CHARLES (MD)
Entity Type:Individual
Prefix:MR
First Name:ADEYINKA
Middle Name:CHARLES
Last Name:ADEJUMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 JUDD ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-4934
Mailing Address - Country:US
Mailing Address - Phone:978-328-2940
Mailing Address - Fax:
Practice Address - Street 1:2041 VALLEYGATE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3745
Practice Address - Country:US
Practice Address - Phone:910-323-5203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT220068207R00000X, 390200000X
MA272634207R00000X, 390200000X
NC2023-01438207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program