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General NPI Number Information
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NPI Number | 1558196550
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Entity Type | Individual
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Provider Name | ADEWALE KABIR ADEGBENRO MD
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Gender | Male
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 7785 N STATE ST
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City | LOWVILLE
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State | NY
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Zip | 13367-1229
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Country | US
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Telephone | 315-376-9626
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Fax | 315-376-5444
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Provider Business Mailing Address
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Address Line | 6417 PHANTOM MOON WALK
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City | CLARKSVILLE
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State | MD
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Zip | 21029-1283
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Country | US
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Telephone | 804-624-0360
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 332697
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 86144
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License Number State | WI
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