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General NPI Number Information
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NPI Number | 1053654814
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Entity Type | Individual
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Provider Name | GBENGA ADEYEMI ADEYEYE DO
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Gender | Male
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Dates
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Enumeration Date | 03/30/2013
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 9000 FRANKLIN SQUARE DR
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City | BALTIMORE
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State | MD
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Zip | 21237-3901
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Country | US
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Telephone | 757-619-2749
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 RACHEL TER APT 18
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City | PINE BROOK
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State | NJ
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Zip | 07058-9360
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Country | US
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Telephone | 757-343-1829
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C05998
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110004213
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 330954
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License Number State | NY
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