Provider Demographics
NPI:1699087403
Name:FADITAN, BABAJIDE EYITAYO (MD)
Entity type:Individual
Prefix:DR
First Name:BABAJIDE
Middle Name:EYITAYO
Last Name:FADITAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 MERCANTILE LN STE 217
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5388
Mailing Address - Country:US
Mailing Address - Phone:301-341-5000
Mailing Address - Fax:301-341-5001
Practice Address - Street 1:1450 MERCANTILE LN STE 217
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5388
Practice Address - Country:US
Practice Address - Phone:301-341-5000
Practice Address - Fax:301-341-5001
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD74464208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD378100300Medicaid
MD248716ZFBKMedicare PIN