Provider Demographics
NPI:1992388219
Name:ADEBAMOWO, DEBORAH OLUFUNMILAYO (MD)
Entity Type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:OLUFUNMILAYO
Last Name:ADEBAMOWO
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 1:1 GUTHRIE SQUARE
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840
Mailing Address - Country:US
Mailing Address - Phone:570-887-2239
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQUARE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840
Practice Address - Country:US
Practice Address - Phone:570-887-2239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2023-04-20
Deactivation Date:2023-03-23
Deactivation Code:
Reactivation Date:2023-04-20
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMT223602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program