Provider Demographics
NPI:1295994242
Name:FALOKUN, ADEDAMOLA ADETOLA (MD)
Entity type:Individual
Prefix:DR
First Name:ADEDAMOLA
Middle Name:ADETOLA
Last Name:FALOKUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ADEDAMOLA
Other - Middle Name:ADETOLA
Other - Last Name:ADEGBENRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-2400
Mailing Address - Fax:717-812-3005
Practice Address - Street 1:96 SOFIA DR STE 208
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-5201
Practice Address - Country:US
Practice Address - Phone:717-812-2400
Practice Address - Fax:717-812-3005
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116022246207Q00000X
MDD0070061207Q00000X
PAMD469330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD244074YVZMedicare PIN
MD328035YWV2Medicare PIN
MD244074ZDDBMedicare PIN