Basic Information
| Provider Information | |||||||||
| NPI: | 1568994168 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AJAYI | ||||||||
| FirstName: | AYOBAMI | ||||||||
| MiddleName: | OMOLOLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 SPRUCE ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007897366 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2730 UNIVERSITY BLVD W STE 104 | ||||||||
| Address2: | |||||||||
| City: | WHEATON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209021979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019428799 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2017 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | M106359 | MD | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.