Individual provider Active NPI

Adjoavi Fakonam Andele, M.D.

  • Obstetrics & Gynecology Physician
  • Hagerstown, MD
National Provider Identifier
1972530202
Registry record updated Dec 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
D0064550 Issued in MD
Practice address
1130 Professional CT
Hagerstown, MD 21740-5852
Phone
(301) 791-5555
Fax
(301) 791-8104
NPI assigned
Jun 26, 2006
Last updated
Dec 11, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X D0064550 MD Primary

Addresses

Primary practice location

1130 Professional CT
Hagerstown, MD 21740-5852

Mailing address

11116 Medical Campus Rd
Hagerstown, MD 21742-6710

Other identifiers 1

IdentifierTypeStateIssuer
D0064550OtherMDDHMH LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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 1

Enrollment IDStateProvider typePAC IDDetails
I20070212000607 MD Practitioner - Obstetrics/Gynecology 9931101466 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
University of Louisville School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Meritus Medical Center IncGroup PAC ID 7113811795, shared by 8 NPIs, 730 clinicians

Practice addresses (Care Compare)

11110 Medical Campus Rd
Hagerstown, MD 21742-6700

11110 Medical Campus Rd
Suite 107
Hagerstown, MD 21742-6734
Phone (301) 714-4100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D0064550MDMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Practices of Antietam, LLC CurrentSince Oct 1, 2008 Accepting new patients
Medical Practices of Antietam LLC CurrentSince Oct 1, 2008 Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Locations

11110 Medical Campus Rd
Hagerstown, MD 21742
Phone (240) 313-9800

11110 Medical Campus Rd
Ste 107
Hagerstown, MD 21742
Phone (301) 714-4100

11110 Medical Campus Rd
Ste 229
Hagerstown, MD 21742
Phone (301) 665-4500

11110 Medical Campus Rd
Ste 249
Hagerstown, MD 21742
Phone (301) 665-9098

11116 Medical Campus Rd
Hagerstown, MD 21742
Phone (301) 766-7600

1130 Professional Ct
Hagerstown, MD 21740
Phone (301) 791-5555

3 Byrkit Dr
Williamsport, MD 21795
Phone (301) 582-1150

Organizations & group practices 3

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1972530202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11116 MEDICAL CAMPUS RD",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 PROFESSIONAL CT",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217405852",
            "telephone_number": "301-791-5555",
            "fax_number": "301-791-8104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDELE",
        "first_name": "ADJOAVI",
        "middle_name": "FAKONAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-26",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MD",
            "license": "D0064550",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHMH LICENSE",
            "identifier": "D0064550",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hagerstown, MD

Sources for this page

Verify at the official NPI Registry.