Provider Demographics
NPI:1376092700
Name:ADEKOLA, ABDULAHI
Entity Type:Individual
Prefix:
First Name:ABDULAHI
Middle Name:
Last Name:ADEKOLA
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 1:14 SHARON CT
Mailing Address - Street 2:APT 102
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 SHARON CT
Practice Address - Street 2:APT. 102
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4542
Practice Address - Country:US
Practice Address - Phone:443-470-2579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12422374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide