Provider Demographics
NPI:1770113250
Name:ADETUNJI IDOWU, BOSEDE O
Entity type:Individual
Prefix:
First Name:BOSEDE
Middle Name:O
Last Name:ADETUNJI IDOWU
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 1:5006 BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-5101
Mailing Address - Country:US
Mailing Address - Phone:410-488-5171
Mailing Address - Fax:410-488-5173
Practice Address - Street 1:2901 DRUID PARK DR STE A202
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-8131
Practice Address - Country:US
Practice Address - Phone:410-488-5171
Practice Address - Fax:410-488-5173
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health