Provider Demographics
NPI:1861498685
Name:ADETOLA, ADEDAYO (MD)
Entity Type:Individual
Prefix:
First Name:ADEDAYO
Middle Name:
Last Name:ADETOLA
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 1:1453 WHALLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516
Mailing Address - Country:US
Mailing Address - Phone:203-389-4111
Mailing Address - Fax:203-889-4953
Practice Address - Street 1:1453 WHALLEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1153
Practice Address - Country:US
Practice Address - Phone:203-389-4111
Practice Address - Fax:203-889-4953
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036356207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001363564Medicaid
CT2326523OtherAETNA
CT010036356CT02OtherANTHEM BLUE SHIELD
CT0V7682OtherHEALTHNET
CT751871OtherCONNECTICARE
CT110195767OtherRAILROAD MEDICARE
CTP2061616OtherOXFORD
CTG89012Medicare UPIN
CTD400107025Medicare PIN