Healthcare Provider Details

I. General information

NPI: 1871759480
Provider Name (Legal Business Name): TOLULOPE KOFI AKINYEMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TOLU KOFI AKINYEMI MD

II. Dates (important events)

Enumeration Date: 08/03/2008
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GRIFFIN RD SUITE 6
PORTSMOUTH NH
03801-7145
US

IV. Provider business mailing address

200 GRIFFIN RD SUITE 6
PORTSMOUTH NH
03801-7145
US

V. Phone/Fax

Practice location:
  • Phone: 603-610-4430
  • Fax: 603-610-4432
Mailing address:
  • Phone: 603-610-4430
  • Fax: 603-610-4432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD441385
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberLT-3628
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: