Provider Demographics
NPI:1457559296
Name:LAWAL, MOSHOOD ADEBAYO (MD)
Entity type:Individual
Prefix:DR
First Name:MOSHOOD
Middle Name:ADEBAYO
Last Name:LAWAL
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 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9422
Mailing Address - Country:US
Mailing Address - Phone:207-283-7000
Mailing Address - Fax:
Practice Address - Street 1:1165 W LODGEWOOD CT
Practice Address - Street 2:
Practice Address - City:RIVER HILLS
Practice Address - State:WI
Practice Address - Zip Code:53217-1637
Practice Address - Country:US
Practice Address - Phone:770-490-1156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METD091053208M00000X
WI50599207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30208893Medicaid
ME434469299Medicaid
ME001253401Medicare PIN