MEDICARE: ADEBUSOLA A MATILUKURO

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	251E00000X	Home Health Agency	R172791	MD
2	374U00000X	Home Health Aide	R172791	MD
3	163WH0200X	Home Health Registered Nurse	R172791	MD

General Provider Information

NPI Number	:	1609131424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEBUSOLA A MATILUKURO

Provider Business Mailing Address
First Line	:	9902 CLEARY LN
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-2804
Country	:	US
Telephone Number	:	301-821-6074
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 DANSHIRE CT
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20721-3040
Country	:	US
Telephone Number	:	301-974-1094
Fax Number	:

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

Provider Enumeration Date	:	07/09/2012
Last Update Date	:	11/10/2025

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