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9510 University City Blvd Ste 102 Charlotte NC 28213-3997 | |
(704) 833-8037 | |
(704) 691-0415 |
Full Name | |
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Speciality | Internal Medicine |
Location | 9510 University City Blvd Ste 102, Charlotte, North Carolina |
Authorized Official Name and Position | Lanre Ladipo (ADMINISTRATOR) |
Authorized Official Contact | 7048338037 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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9510 University City Blvd Ste 102 Charlotte NC 28213-3997 Ph: (704) 833-8037 | 9510 University City Blvd Ste 102 Charlotte NC 28213-3997 Ph: (704) 833-8037 |
NPI Number | 1316627771 |
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Provider Enumeration Date | 07/20/2023 |
Last Update Date | 12/25/2023 |
Medicare PECOS PAC ID | 3577005834 |
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Medicare Enrollment ID | O20240603001713 |
Identifier | Type | State | Issuer |
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1316627771 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Olusola Joseph |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1922470723 PECOS PAC ID: 5193017705 Enrollment ID: I20160629002826 |
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