Provider Demographics
NPI:1871759480
Name:AKINYEMI, TOLULOPE KOFI (MD)
Entity type:Individual
Prefix:DR
First Name:TOLULOPE
Middle Name:KOFI
Last Name:AKINYEMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TOLU
Other - Middle Name:KOFI
Other - Last Name:AKINYEMI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:200 GRIFFIN RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7145
Mailing Address - Country:US
Mailing Address - Phone:603-610-4430
Mailing Address - Fax:603-610-4432
Practice Address - Street 1:200 GRIFFIN RD
Practice Address - Street 2:SUITE 6
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7145
Practice Address - Country:US
Practice Address - Phone:603-610-4430
Practice Address - Fax:603-610-4432
Is Sole Proprietor?:No
Enumeration Date:2008-08-03
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4413852086S0129X
NHLT-36282086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102742655Medicaid
PA2719120OtherHIGHMARK BLUE SHIELD
PA1610609OtherGATEWAY
MD055948200Medicaid
PA30126260OtherAMERIHEALTH MERCY - WMG
MD055948200Medicaid
PA2719120OtherHIGHMARK BLUE SHIELD