Provider Demographics
NPI:1821364878
Name:TINU ADDAMS MEDICAL
Entity Type:Organization
Organization Name:TINU ADDAMS MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ATINUKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OGUNLADE-ADDAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-563-7766
Mailing Address - Street 1:1200 JEFFERSON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-3158
Mailing Address - Country:US
Mailing Address - Phone:585-563-7766
Mailing Address - Fax:
Practice Address - Street 1:1200 JEFFERSON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-3158
Practice Address - Country:US
Practice Address - Phone:585-563-7766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2319152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0584Medicare PIN