Healthcare Provider Details

I. General information

NPI: 1033372891
Provider Name (Legal Business Name): ADEBIMPE OLUBUSAYO ADEWUSI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST PORTER 005
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST PORTER 005
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-2877
  • Fax: 401-444-3804
Mailing address:
  • Phone: 401-444-2877
  • Fax: 401-444-3804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberMD442550
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD442550
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMT193447
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License NumberMD14548
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: