Provider Demographics
NPI:1972701761
Name:OYEMADE, ADEGBOYEGA A (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEGBOYEGA
Middle Name:A
Last Name:OYEMADE
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 1:10128 BRACKEN DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1673
Mailing Address - Country:US
Mailing Address - Phone:443-542-9121
Mailing Address - Fax:
Practice Address - Street 1:7141 SECURITY BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-1800
Practice Address - Country:US
Practice Address - Phone:443-663-6329
Practice Address - Fax:443-663-6026
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00747992084P0800X, 2084P0802X
IL036-1171182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK40936Medicare PIN