Individual provider Active NPI

Ibukunola Olaitan Adediji, PA

  • Internal Medicine Physician
  • Baltimore, MD
National Provider Identifier
1386240455
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C0007794 Issued in MD
Practice address
9000 Franklin Square Dr
Baltimore, MD 21237-3901
Phone
(443) 777-7000
NPI assigned
Dec 4, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X C0007794 MD Primary

Addresses

Primary practice location

9000 Franklin Square Dr
Baltimore, MD 21237-3901

Mailing address

2939 Siwanoy Dr
Edgewood, MD 21040-3436
Phone (443) 616-8554

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210129000505 MD Practitioner - Physician Assistant 5092129270 Reassigns benefits to 2 organizations
I20210812000073 DC Practitioner - Physician Assistant 5092129270 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
MNR Industries, LLCGroup PAC ID 7416908843, 142 clinicians

Practice addresses (Care Compare)

1307 Merritt Blvd
Dundalk, MD 21222-2109
Phone (410) 288-2121

1354 Eastern Blvd
Expresscare of Essex
Essex, MD 21221-3423
Phone (443) 231-5203

1470 Martin Blvd
Middle River, MD 21220-4105
Phone (443) 231-5203

1505 E Churchville Rd
Bel Air, MD 21014-4742

2006 Rock Spring Rd
Forest Hill, MD 21050-2607
Phone (410) 569-0044

2401 E Belvedere Ave
Baltimore, MD 21215-5216

4009 N Point Blvd
105 Expresscare of North Point
Dundalk, MD 21222-3619
Phone (410) 477-1039

5 Bel Air S Pkwy
Suite 1535
Bel Air, MD 21015-3816
Phone (410) 569-0044

7700 Belair Rd
Baltimore, MD 21236-4004
Phone (410) 665-0670

7701 Harford Rd
Parkville, MD 21234-6403
Phone (410) 569-0069

8000 Loch Raven Blvd
Loch Raven, MD 21286-8337
Phone (410) 616-9027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
C0007794MDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MNR Industries LLC Current Accepting new patients
MNR Industries, LLC CurrentSince Jul 1, 2021 Accepting new patients
MNR Industries, LLC CurrentSince Jul 1, 2021 Accepting new patients
MNR Industries, LLC CurrentSince Jul 1, 2021 Accepting new patients

Locations

1505 E Churchville Rd
#A
Bel Air, MD 21014
Phone (410) 420-6970

1505 E Churchville Rd
Bel Air, MD 21014
Phone (410) 420-6970

6000 Laurel Bowie Rd
Bowie, MD 20715
Phone (301) 383-0330

504 E Ridgeville Blvd
#A
Mount Airy, MD 21771
Phone (301) 703-5452

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1607040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1386240455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2939 SIWANOY DR",
            "city": "EDGEWOOD",
            "state": "MD",
            "postal_code": "210403436",
            "telephone_number": "443-616-8554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 FRANKLIN SQUARE DR",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212373901",
            "telephone_number": "443-777-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADEDIJI",
        "first_name": "IBUKUNOLA",
        "middle_name": "OLAITAN",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-04",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": "C0007794",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.