Healthcare Provider Details

I. General information

NPI: 1326625021
Provider Name (Legal Business Name): ADEYEMI VICTOR SOFOLUWE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 CHESTNUT ST
SPRINGFIELD MA
01199-2646
US

IV. Provider business mailing address

759 CHESTNUT ST
SPRINGFIELD MA
01199-2646
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-0000
  • Fax: 617-414-5315
Mailing address:
  • Phone: 413-794-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD-56752
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: