Healthcare Provider Details

I. General information

NPI: 1699453498
Provider Name (Legal Business Name): AYODEJI ADELEKE DINA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE STREET
BRIGHTON MA
02135
US

IV. Provider business mailing address

736 CAMBRIDGE STREET
BRIGHTON MA
02135
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-2456
  • Fax: 617-562-7755
Mailing address:
  • Phone: 617-789-2456
  • Fax: 617-562-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35411
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number3013654
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: