Provider Demographics
NPI:1417220146
Name:ADEFOWOKAN, ROTANNA I (MD)
Entity type:Individual
Prefix:DR
First Name:ROTANNA
Middle Name:I
Last Name:ADEFOWOKAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROTANNA
Other - Middle Name:I
Other - Last Name:ANOSIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:826 HARBORTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-2972
Mailing Address - Country:US
Mailing Address - Phone:732-423-0761
Mailing Address - Fax:
Practice Address - Street 1:826 HARBORTOWN BLVD
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-2972
Practice Address - Country:US
Practice Address - Phone:732-423-0761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ390200000X
PAMD445239207V00000X
NJ25MA09375600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program