Provider Demographics
NPI:1275890816
Name:AJIBADE, DARE VICTOR (MD/PHD/MPH)
Entity Type:Individual
Prefix:DR
First Name:DARE
Middle Name:VICTOR
Last Name:AJIBADE
Suffix:
Gender:M
Credentials:MD/PHD/MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 OLD SHORT HILLS RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5672
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8714 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3601
Practice Address - Country:US
Practice Address - Phone:301-276-4683
Practice Address - Fax:301-589-2007
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD2100017482086S0122X
VA01012733172086S0122X
MDD00929272086S0122X
PAMD4629052086S0122X
NJ25MA099018002086S0122X
TXS27102086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery