Active NPI
Andria Adegbesan
- Speech-Language Pathologist
- Glen Burnie, MD
National Provider Identifier
1578033544
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- Practice address
- 415 Melrose Ave
Glen Burnie, MD 21061-2050 - Phone
- (410) 222-6409
- NPI assigned
- Dec 3, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | Primary |
Addresses
Primary practice location
415 Melrose Ave
Glen Burnie, MD 21061-2050
Mailing address
415 Melrose Ave
Glen Burnie, MD 21061-2050
Phone (410) 222-6409
Other practice location 1
115 Sudbrook Ln Ste A
Pikesville, MD 21208-4184
Phone (410) 358-1997
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7408 | Medicaid | MD |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1543795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597968000000",
"number": "1578033544",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 MELROSE AVE",
"city": "GLEN BURNIE",
"state": "MD",
"postal_code": "210612050",
"telephone_number": "410-222-6409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 MELROSE AVE",
"city": "GLEN BURNIE",
"state": "MD",
"postal_code": "210612050",
"telephone_number": "410-222-6409"
}
],
"practiceLocations": [
{
"address_1": "115 Sudbrook Ln Ste A",
"address_purpose": "LOCATION",
"city": "Pikesville",
"state": "MD",
"postal_code": "212084184",
"country_code": "US",
"telephone_number": "410-358-1997",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ADEGBESAN",
"first_name": "ANDRIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-12-03",
"last_updated": "2020-08-21",
"certification_date": "2020-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7408",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Glen Burnie, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.