Active NPI
Gabriel Aderemi Fayomi, PA-C
- Physician Assistant
- Washington, DC
National Provider Identifier
1245448000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA267
- Practice address
- 920 Varnum St NE
Washington, DC 20017-2145 - Phone
- (202) 269-7400
- Fax
- (202) 269-7823
- NPI assigned
- May 17, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA267 | DC | Primary |
Addresses
Primary practice location
920 Varnum St NE
Washington, DC 20017-2145
Mailing address
11000 Elon Dr
Bowie, MD 20720-3507
Phone (301) 352-0308
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA267 | DC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245448000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11000 ELON DR",
"city": "BOWIE",
"state": "MD",
"postal_code": "207203507",
"telephone_number": "301-352-0308"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "920 VARNUM ST NE",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200172145",
"telephone_number": "202-269-7400",
"fax_number": "202-269-7823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAYOMI",
"first_name": "GABRIEL",
"middle_name": "ADEREMI",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "DC",
"license": "PA267",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.