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NPI Code Detail

MEDICARE: DR. ADETUTU BASIRAT ADETONA M.D.

MEDICARE: DR. ADETUTU BASIRAT ADETONA 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
1207Q00000XFamily Medicine Physician205662-1NY

Other Identifiers

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

General Provider Information

NPI Number : 1629038930
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ADETUTU BASIRAT ADETONA M.D.
Provider Business Mailing Address
First Line : 595 5TH AVE
Second Line :
City : TROY
State : NY
Zip : 12182-2501
Country : US
Telephone Number : 518-235-8034
Fax Number : 518-235-8036
Provider Business Practice Location Address
First Line : 595 5TH AVE
Second Line :
City : TROY
State : NY
Zip : 12182-2501
Country : US
Telephone Number : 518-235-8034
Fax Number : 518-235-8036
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 01/30/2020

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