Basic Information
| Provider Information | |||||||||
| NPI: | 1801057062 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADEYIGA | ||||||||
| FirstName: | ADEBUNMI | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8008 WESTPARK DR | ||||||||
| Address2: | |||||||||
| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221023109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032876400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8008 WESTPARK DR | ||||||||
| Address2: | |||||||||
| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221023109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032876400 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2008 | ||||||||
| LastUpdateDate: | 06/23/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085P0229X | 243440 | MA | Y | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology |
No ID Information.