Provider Demographics
NPI:1952420580
Name:ADEYEMI, ADEBOWALE A (MD)
Entity Type:Individual
Prefix:DR
First Name:ADEBOWALE
Middle Name:A
Last Name:ADEYEMI
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:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-6212
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1600 ROCKLAND ROAD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803
Practice Address - Country:US
Practice Address - Phone:302-651-4000
Practice Address - Fax:302-651-5838
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD437152208000000X, 2080P0206X
DEC1-0009070208000000X, 2080P0206X
PAMT2155752080T0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080T0004XAllopathic & Osteopathic PhysiciansPediatricsPediatric Transplant Hepatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ020495Medicaid