Provider Demographics
NPI:1629156955
Name:ADEGBULUGBE, HENRY A (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:A
Last Name:ADEGBULUGBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3027
Mailing Address - Country:US
Mailing Address - Phone:202-595-3223
Mailing Address - Fax:202-865-2985
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-4164
Practice Address - Fax:202-865-7407
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056536207V00000X
DCMD034494207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD383302000Medicaid
MD383302000Medicaid
MD014840D76Medicare ID - Type Unspecified