Provider Demographics
NPI:1346346889
Name:OKOROAFOR, KINGSLEY UZO (MD)
Entity Type:Individual
Prefix:DR
First Name:KINGSLEY
Middle Name:UZO
Last Name:OKOROAFOR
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 1:1315 AVON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4423
Mailing Address - Country:US
Mailing Address - Phone:910-703-8718
Mailing Address - Fax:910-703-8721
Practice Address - Street 1:1315 AVON ST STE 103
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4423
Practice Address - Country:US
Practice Address - Phone:910-703-8718
Practice Address - Fax:910-703-8721
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500969207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200500969OtherMEDICAL LICENSE NUMBER
NC5901175Medicaid
NCI38844Medicare UPIN
NC2045001Medicare ID - Type Unspecified