Healthcare Provider Details

I. General information

NPI: 1972701761
Provider Name (Legal Business Name): ADEGBOYEGA A OYEMADE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 04/25/2024
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7141 SECURITY BLVD
BALTIMORE MD
21244-1800
US

IV. Provider business mailing address

10128 BRACKEN DR
ELLICOTT CITY MD
21042-1673
US

V. Phone/Fax

Practice location:
  • Phone: 443-663-6329
  • Fax: 443-663-6026
Mailing address:
  • Phone: 443-542-9121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0074799
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberD0074799
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036-117118
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: