Basic Information
Provider Information
NPI: 1033556675
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADABONYAN
FirstName: IFEOLUWA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12500 WILLOWBROOK RD
Address2: EMERGENCY DEPARTMENT
City: CUMBERLAND
State: MD
PostalCode: 215026393
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 12500 WILLOWBROOK RD
Address2: EMERGENCY DEPARTMENT
City: CUMBERLAND
State: MD
PostalCode: 215026393
CountryCode: US
TelephoneNumber: 2409641200
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/22/2013
LastUpdateDate: 10/01/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XD0081004MDY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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