Provider Demographics
NPI:1124111000
Name:MESIOYE, ABISOLA BERNICE (MD)
Entity type:Individual
Prefix:DR
First Name:ABISOLA
Middle Name:BERNICE
Last Name:MESIOYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ABISOLA
Other - Middle Name:BERNICE
Other - Last Name:FAMAKINWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3900 LOCH RAVEN BLVD
Mailing Address - Street 2:VA MARYLAND HEALTH CARE SYSTEM
Mailing Address - City:BALTOMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:410-605-7522
Mailing Address - Fax:781-687-2228
Practice Address - Street 1:200 SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1114
Practice Address - Country:US
Practice Address - Phone:781-687-2813
Practice Address - Fax:781-687-2228
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208533207R00000X
ME208533207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H51388Medicare UPIN
A36590Medicare ID - Type Unspecified