MEDICARE: DR. ABAYOMI FAKUNLE

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	174400000X	Specialist	D25326	MD

General Provider Information

NPI Number	:	1235349341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABAYOMI FAKUNLE

Provider Business Mailing Address
First Line	:	13318 ROYDEN CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21042-1218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 WOODLAWN DR
Second Line	:	SUITE M
City	:	BALTIMORE
State	:	MD
Zip	:	21207-4023
Country	:	US
Telephone Number	:	410-298-3482
Fax Number	:	410-298-0314

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. ABAYOMI FAKUNLE ” Practice Location

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