Provider Demographics
NPI:1316920838
Name:ADEWOYE, ADEBOYE H (MD)
Entity type:Individual
Prefix:
First Name:ADEBOYE
Middle Name:H
Last Name:ADEWOYE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 ALBANY ST
Mailing Address - Street 2:X-4
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:732 HARRISON AVE
Practice Address - Street 2:PRESTON-3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2656
Practice Address - Country:US
Practice Address - Phone:617-638-6428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203479207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0193704Medicaid
MA0193704Medicaid
MAH61668Medicare UPIN