Provider Demographics
NPI:1487400909
Name:ADEWUMI, ABIMBOLA YEWANDE
Entity type:Individual
Prefix:
First Name:ABIMBOLA
Middle Name:YEWANDE
Last Name:ADEWUMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 MOONFLOWER CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-1011
Mailing Address - Country:US
Mailing Address - Phone:443-854-3059
Mailing Address - Fax:
Practice Address - Street 1:6630 MOONFLOWER CT
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-1011
Practice Address - Country:US
Practice Address - Phone:443-854-3059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRSA-01653251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health