Provider Demographics
NPI:1619600400
Name:AJAYI, OMOTOLA ADERIYIKE (MD)
Entity Type:Individual
Prefix:DR
First Name:OMOTOLA
Middle Name:ADERIYIKE
Last Name:AJAYI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OMOTOLA
Other - Middle Name:ADERIYIKE
Other - Last Name:ADELEYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 LONGWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-6000
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2023-03-27
Deactivation Date:2023-03-13
Deactivation Code:
Reactivation Date:2023-03-27
Provider Licenses
StateLicense IDTaxonomies
MA292983390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program