Basic Information
| Provider Information | |||||||||
| NPI: | 1932324985 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADEROJU | ||||||||
| FirstName: | ADEMOLA | ||||||||
| MiddleName: | OLUBUSOLA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602658 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367162011 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1404 WILLOW LN | ||||||||
| Address2: | SUITE B | ||||||||
| City: | NORTH WILKESBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286593584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369036820 | ||||||||
| FaxNumber: | 3369036821 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2008-01398 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RG0100X | 2008-01398 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 5910809 | 05 | NC | MEDICAID |