Ebenezer Kolade, M.D.

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

License

040029 Issued in CT

Practice address

4675 Main St
Bridgeport, CT 06606-1813

Phone

(203) 372-3333

Fax

(203) 374-7515

NPI assigned

Nov 22, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT, GA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Addiction MedicineAlso: Internal Medicine

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hygeia Health

  • Substance Abuse Rehabilitation Facility
  • Riverdale, GA
  • NPI 1619766219

  Addiction Medicine

  Medicare reassignment NPD Authorized official
• New Era Rehabilitation Center, Inc

  • Methadone Clinic
  • Bridgeport, CT
  • NPI 1255372108
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1376618611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4675 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066061813",
            "telephone_number": "203-372-3333",
            "fax_number": "203-374-7515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4675 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066061813",
            "telephone_number": "203-372-3333",
            "fax_number": "203-374-7515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLADE",
        "first_name": "EBENEZER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "CT",
            "license": "040029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Kobliner, LPC-A
• Charles Edward Kochan Jr., M.D.
• Henna Kaur Kochar, MD
• Yevgenia Kochian, LPC
• Christina Kolade, D.O.
• Jennifer Elovich Kolakowski, LSCW
• Patricia Kolbusz
• Michele Diane Koleszar, M.D.
• Tessa Rose Konczylo, PA-C
• Mikhail Kondratiuk, M.D.

• Addiction Medicine (Internal Medicine) Physician in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Addiction Medicine (Internal Medicine) Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.