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General NPI Number Information
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NPI Number | 1821015264
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Entity Type | Organization
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Legal Business Name | BENJAMIN ADEWALE MD PC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 7011 CALAMO ST #105
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City | SPRINGFIELD
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State | VA
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Zip | 22150
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Country | US
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Telephone | 703-569-8028
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Fax | 703-569-8085
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Provider Business Mailing Address
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Address Line | PO BOX 8057
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City | ALEXANDRIA
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State | VA
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Zip | 22306-8057
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR MD
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Name | BENJAMIN ADYSON ADENWALE
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Credential | MD
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Telephone | 703-569-8028
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number | 0101054165
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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