Provider Demographics
NPI:1104898600
Name:MABADEJE, ADETAYO S (MD)
Entity type:Individual
Prefix:
First Name:ADETAYO
Middle Name:S
Last Name:MABADEJE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3945
Mailing Address - Street 2:DEPT 841
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3945
Mailing Address - Country:US
Mailing Address - Phone:281-358-8114
Mailing Address - Fax:281-358-0609
Practice Address - Street 1:4000 SPENCER HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1202
Practice Address - Country:US
Practice Address - Phone:713-359-2000
Practice Address - Fax:713-359-1004
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235560208VP0000X
TXM5824207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00416927OtherRAILROAD MEDICARE
VA1003493OtherVA PREMIER
VA100988OtherANTHEM
TX8AA961OtherBCSB
VA230920OtherSOUTHERN HEALTH
TX8W7376OtherBLUE CROSS PROVIDER ID
VA2224992OtherFIRST HEALTH
VA73866OtherOPTIMA
TX188438902Medicaid
TX188438903Medicaid
VAP00091266OtherPALMETTO
TXP00817171OtherRR MCR
VA010034931Medicaid
TX1884389 01Medicaid
VA7486021OtherCIGNA
TXP00817171OtherRR MCR
TX8AA961OtherBCSB
VA7486021OtherCIGNA
TXTXB132196Medicare PIN
TX8L12094Medicare PIN