Healthcare Provider Details

I. General information

NPI: 1134278849
Provider Name (Legal Business Name): ONIKEPE ADEGBOLA MD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 N HENDERSON RD STE 310
KING OF PRUSSIA PA
19406-2155
US

IV. Provider business mailing address

170 N HENDERSON RD STE 310
KING OF PRUSSIA PA
19406-2155
US

V. Phone/Fax

Practice location:
  • Phone: 610-486-5870
  • Fax: 610-298-9147
Mailing address:
  • Phone: 610-486-5870
  • Fax: 610-298-9147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberMT186720
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number45473
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD438058
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: