1316993462 NPI number — ADEDIJI OSINLOYE M.D.

Table of content: ADEDIJI OSINLOYE M.D. (NPI 1316993462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316993462 NPI number — ADEDIJI OSINLOYE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSINLOYE
Provider First Name:
ADEDIJI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316993462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10922 S TRYON ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28273-4151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-368-7540
Provider Business Mailing Address Fax Number:
704-368-7541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10922 S TRYON ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28273-4151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-368-7540
Provider Business Practice Location Address Fax Number:
704-368-7541
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  2004-01293 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 31254 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 200401293 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 13827 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5900627 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26-2140977 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26-2140977 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 26-2140977 . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 26-2140977 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26-21400977 . This is a "PACIFICARE" identifier . This identifiers is of the category "OTHER".




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