MEDICARE: ADEKUNLE A. FAJANA 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	207R00000X	Internal Medicine Physician	73428	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396727806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEKUNLE A. FAJANA M.D.

Provider Business Mailing Address
First Line	:	390 MAIN ST
Second Line	:	SUITE 509
City	:	WORCESTER
State	:	MA
Zip	:	01608-2583
Country	:	US
Telephone Number	:	508-753-4151
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 MAIN ST
Second Line	:	SUITE 509
City	:	WORCESTER
State	:	MA
Zip	:	01608-2583
Country	:	US
Telephone Number	:	508-753-4151
Fax Number	:

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	06/03/2024

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