Provider Demographics
NPI:1710027586
Name:BABATUNDE, IBIDUNNI J (PA)
Entity Type:Individual
Prefix:
First Name:IBIDUNNI
Middle Name:J
Last Name:BABATUNDE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 OLD DOVER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3464
Mailing Address - Country:US
Mailing Address - Phone:603-335-6470
Mailing Address - Fax:603-335-9278
Practice Address - Street 1:25 OLD DOVER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3464
Practice Address - Country:US
Practice Address - Phone:603-335-6470
Practice Address - Fax:603-335-9278
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0288 P363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
551878Medicare UPIN
APO757Medicare ID - Type Unspecified