Provider Demographics
NPI:1669448767
Name:SOSANYA, ADEYEMISI O (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEYEMISI
Middle Name:O
Last Name:SOSANYA
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:PO BOX 922
Mailing Address - Street 2:
Mailing Address - City:BROOKLANDVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21022
Mailing Address - Country:US
Mailing Address - Phone:410-383-4424
Mailing Address - Fax:410-383-7918
Practice Address - Street 1:2600 LIBERTY HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-383-4424
Practice Address - Fax:410-383-7918
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I10407Medicare UPIN
644MI720Medicare ID - Type Unspecified