Benjamin a. Adewale MD PC
Organization Active NPI Mental Health Counselor · Alexandria, VA
NPI 1992073084 · NPPES record last updated Jul 30, 2013
Key facts
- NPI
- 1992073084
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- MD22004 (DC)
- Legal business name
- BENJAMIN A. ADEWALE MD PC
- Practice address
- 25 S Quaker LN
Suite 4
Alexandria, VA 22314-4585 - Phone
- (571) 257-4398
- Fax
- (703) 823-4407
- NPI assigned
- Dec 5, 2011
- Organization subpart
- No
Authorized official
- Name
- Dr. Benjamin Adewale, M.D.
- Title
- Ceo
- Phone
- (703) 569-8028
Other NPIs with the same Medicare PAC ID 1
Subparts reporting this organization as parent 1
Practitioners 9
-
Johnson Komolafe, NP
-
Eunice Okoro, NP
-
Teresa Grant, PH.D.
-
Melanie Charlene Wells, PMHNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130805000799 | DC | Part B Supplier - Clinic/Group Practice | 2961469176 |
Receives reassigned benefits from 1 practitioner Practice locations: Springfield, VA; Alexandria, VA |
National Provider Directory
Locations
25 S Quaker Ln
Ste 35
Alexandria, VA 22314
Phone (571) 257-4398
7011 Calamo St
Ste 105
Springfield, VA 22150
Phone (703) 569-8028
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | MD22004 | DC | Yes |
Addresses
Primary practice location
25 S Quaker LN
Suite 4
Alexandria, VA 22314-4585
Mailing address
25 S Quaker LN
Suite 4
Alexandria, VA 22314-4585
Phone (571) 257-4398
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 031768500 | Medicaid | DC |
Other names
- Riverside Mental and Medical Clinic
Other providers in Alexandria, VA
- Jennifer Brynn Bendokas
- Natasha Benfer
- Mehdi Benhsain
- Emily Benitez
- Marleni Benitez
- David Andrew Benjamin
- Arthur Alexander Bennett III
- Lucky Bennett
- Susan Benson
- Colleen Benstein
All providers in Alexandria, VA · Mental Health Counselor in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.