Provider Demographics
NPI:1437317310
Name:ADEPOJU, OLURANTI A (MD)
Entity Type:Individual
Prefix:
First Name:OLURANTI
Middle Name:A
Last Name:ADEPOJU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 UNION ST STE 317
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-2314
Mailing Address - Country:US
Mailing Address - Phone:617-780-2671
Mailing Address - Fax:
Practice Address - Street 1:33 UNION ST STE 317
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2314
Practice Address - Country:US
Practice Address - Phone:617-855-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2497642084P0800X
CT0480322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110094539AMedicaid
002936601Medicare PIN