Provider Demographics
NPI:1720327893
Name:TRINITY OBSTETRICS & GYNECOLOGY P.C.
Entity Type:Organization
Organization Name:TRINITY OBSTETRICS & GYNECOLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEGBOYEGA
Authorized Official - Middle Name:IBUKUNOLU
Authorized Official - Last Name:ADEJANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-967-3268
Mailing Address - Street 1:8395 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6687
Mailing Address - Country:US
Mailing Address - Phone:410-967-3268
Mailing Address - Fax:410-494-0368
Practice Address - Street 1:8395 ACADEMY RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-6687
Practice Address - Country:US
Practice Address - Phone:410-967-3268
Practice Address - Fax:410-494-0368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD66180207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
013671900Medicare UPIN