Provider Demographics
NPI:1881754349
Name:ADEYEMO, MONISOLA A (NP)
Entity type:Individual
Prefix:MRS
First Name:MONISOLA
Middle Name:A
Last Name:ADEYEMO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 BOX OAK CT
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2386
Mailing Address - Country:US
Mailing Address - Phone:301-925-7022
Mailing Address - Fax:301-925-4463
Practice Address - Street 1:1400 MERCANTILE LN
Practice Address - Street 2:SUITE 180
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5341
Practice Address - Country:US
Practice Address - Phone:301-925-7022
Practice Address - Fax:301-925-4463
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR105387261Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD810600200Medicaid
G02798D01Medicare UPIN