Provider Demographics
NPI:1265850549
Name:AJAYI-OBE, AKINBOLA ADEWOLE (MD)
Entity type:Individual
Prefix:DR
First Name:AKINBOLA
Middle Name:ADEWOLE
Last Name:AJAYI-OBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4600 FORBES BLVD STE A26-301
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4359
Mailing Address - Country:US
Mailing Address - Phone:510-345-8981
Mailing Address - Fax:
Practice Address - Street 1:4600 FORBES BLVD STE A26-301
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4359
Practice Address - Country:US
Practice Address - Phone:510-345-8981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS28421207R00000X
WI68570-20207R00000X
AZ55076207R00000X
VA0101271816207R00000X
TN57102207R00000X, 207RC0200X
NMMD2018-0672207R00000X
MDD0090574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2360817Medicaid
TNQ035335Medicaid