MEDICARE: AYOBAMI OLUFADEJI M.D.

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	207P00000X	Emergency Medicine Physician	277474	MA
2	207P00000X	Emergency Medicine Physician	MD600005225	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	268227	OTHER	MA	MA LIMITED MEDICAL LICENSE

General Provider Information

NPI Number	:	1396194726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYOBAMI OLUFADEJI M.D.

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	410-933-0000
Fax Number	:	410-500-4266

Provider Business Practice Location Address
First Line	:	330 BROOKLINE AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02215-5400
Country	:	US
Telephone Number	:	617-754-2339
Fax Number	:

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

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	04/07/2026

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