Provider Demographics
NPI:1386658128
Name:IGBINADOLOR, AWAWU EKINADOESE (MD)
Entity Type:Individual
Prefix:DR
First Name:AWAWU
Middle Name:EKINADOESE
Last Name:IGBINADOLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E ROOSEVELT BLVD STE 800A
Mailing Address - Street 2:P.O.BOX 528
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5187
Mailing Address - Country:US
Mailing Address - Phone:704-225-0211
Mailing Address - Fax:704-225-0221
Practice Address - Street 1:701 E ROOSEVELT BLVD STE 800A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5187
Practice Address - Country:US
Practice Address - Phone:704-225-0211
Practice Address - Fax:704-225-0221
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001720207RA0000X
SC22084207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89128MXMedicaid
NC89128MXMedicaid
NC2282033EMedicare PIN