MEDICARE: MEDCITY FAMILY CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1093482705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDCITY FAMILY CLINIC LLC

Provider Business Mailing Address
First Line	:	2509 WASHINGTON BLVD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-1406
Country	:	US
Telephone Number	:	443-835-4228
Fax Number	:	833-895-2041

Provider Business Practice Location Address
First Line	:	2509 WASHINGTON BLVD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-1406
Country	:	US
Telephone Number	:	443-565-2408
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. FAITH OLUBUKOLA ADEBULE
Credential	:	PSYD
Telephone Number	:	443-623-3592

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	12/31/2025

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