Provider Demographics
NPI:1174378855
Name:QUADRI, ADEWALE IDRIS
Entity type:Individual
Prefix:MR
First Name:ADEWALE
Middle Name:IDRIS
Last Name:QUADRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12806 PORTIAS PROMISE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5608
Mailing Address - Country:US
Mailing Address - Phone:301-232-2840
Mailing Address - Fax:
Practice Address - Street 1:12806 PORTIAS PROMISE DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5608
Practice Address - Country:US
Practice Address - Phone:301-232-2840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA200003769374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide