Provider Demographics
NPI:1336125707
Name:OJO, BABATUNDE (MD)
Entity Type:Individual
Prefix:DR
First Name:BABATUNDE
Middle Name:
Last Name:OJO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 FORT BRAGG RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-6804
Mailing Address - Country:US
Mailing Address - Phone:910-221-3301
Mailing Address - Fax:910-221-3302
Practice Address - Street 1:1815 FORT BRAGG RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-6804
Practice Address - Country:US
Practice Address - Phone:910-221-3301
Practice Address - Fax:910-221-3302
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901274174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891246HMedicaid
NC1246HOtherBCBS PROVIDER #
NM141861943OtherTAX ID NUMBER
NC2331193Medicare ID - Type Unspecified
NC891246HMedicaid