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NPI Code Detail

MEDICARE: FATAI ADESINA GBADAMOSI MD

MEDICARE: FATAI ADESINA GBADAMOSI MD
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
1207R00000XInternal Medicine Physician248561NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20410964OTHERNYINDEPENDENT HEALTH
300025064402OTHERNYUNIVERA
4000525978004OTHERNYBLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number : 1386693190
Entity Type Code : Individual
Provider Name (Legal Business Name) : FATAI ADESINA GBADAMOSI MD
Provider Business Mailing Address
First Line : 206 S ELMWOOD AVE
Second Line :
City : BUFFALO
State : NY
Zip : 14201-2398
Country : US
Telephone Number : 716-847-0328
Fax Number : 716-847-2715
Provider Business Practice Location Address
First Line : 206 S ELMWOOD AVE
Second Line :
City : BUFFALO
State : NY
Zip : 14201-2398
Country : US
Telephone Number : 716-847-0328
Fax Number : 716-847-2715
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2006
Last Update Date : 12/09/2011

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Directions to “ FATAI ADESINA GBADAMOSI MD” Practice Location

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