Provider Demographics
NPI:1558637363
Name:DADA, DAVID ABOLARIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ABOLARIN
Last Name:DADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:12901 BRUCE B DOWNS BLVD # 41
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4742
Mailing Address - Country:US
Mailing Address - Phone:813-844-7412
Mailing Address - Fax:813-974-8359
Practice Address - Street 1:340 HEALD WAY
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-6087
Practice Address - Country:US
Practice Address - Phone:352-259-5762
Practice Address - Fax:352-360-6582
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1122902084P0800X
FLME1122902084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008317300Medicaid
FLHA948OtherMEDICARE PTAN