Provider Demographics
NPI:1336329036
Name:ADERINTO, ADEWALE SOLOMON (DPM)
Entity Type:Individual
Prefix:
First Name:ADEWALE
Middle Name:SOLOMON
Last Name:ADERINTO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 EASTERN AVE
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:FAIRMOUNT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-6500
Mailing Address - Country:US
Mailing Address - Phone:301-925-8007
Mailing Address - Fax:301-574-4165
Practice Address - Street 1:601 EASTERN AVE
Practice Address - Street 2:SUITE # 103
Practice Address - City:FAIRMOUNT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-6500
Practice Address - Country:US
Practice Address - Phone:301-925-8007
Practice Address - Fax:301-574-4165
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01198213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U50828OtherUPIN
00B325A63Medicare PIN