Provider Demographics
NPI:1871752717
Name:SANNOH, YETUNDE ADEDUNNI (MD)
Entity type:Individual
Prefix:
First Name:YETUNDE
Middle Name:ADEDUNNI
Last Name:SANNOH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YETUNDE
Other - Middle Name:ADEDUNNI
Other - Last Name:ADERIBIGBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9500 MARLBORO PIKE STE 12
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3766
Mailing Address - Country:US
Mailing Address - Phone:202-870-7275
Mailing Address - Fax:301-494-8506
Practice Address - Street 1:9500 MARLBORO PIKE STE 12
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3766
Practice Address - Country:US
Practice Address - Phone:301-494-1006
Practice Address - Fax:301-494-8506
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD75522207R00000X
GA063346207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA164455019CMedicaid