Healthcare Provider Details

I. General information

NPI: 1720411036
Provider Name (Legal Business Name): MR. DANIEL ADEYEMO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2013
Last Update Date: 08/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8319 LIBERTY RD
WINDSOR MILL MD
21244-3127
US

IV. Provider business mailing address

8319 LIBERTY RD
WINDSOR MILL MD
21244-3127
US

V. Phone/Fax

Practice location:
  • Phone: 443-271-4536
  • Fax: 410-701-7375
Mailing address:
  • Phone: 443-271-4536
  • Fax: 410-701-7375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberMT0044255
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: