Healthcare Provider Details

I. General information

NPI: 1356263115
Provider Name (Legal Business Name): TOBILOBA GABRIEL ADEYEMI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 VICTORY DR
HALETHORPE MD
21227-2936
US

IV. Provider business mailing address

1915 VICTORY DR
HALETHORPE MD
21227-2936
US

V. Phone/Fax

Practice location:
  • Phone: 443-537-8025
  • Fax:
Mailing address:
  • Phone: 443-537-8025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: