Provider Demographics
NPI:1437106887
Name:BAKARE, MOBOLAJI BABATOPE
Entity Type:Individual
Prefix:DR
First Name:MOBOLAJI
Middle Name:BABATOPE
Last Name:BAKARE
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:MOBOLAJI
Other - Middle Name:
Other - Last Name:BAKARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-718-8383
Mailing Address - Fax:336-718-9622
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-8383
Practice Address - Fax:336-718-9622
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01273208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7453359OtherAETNA
NC141076Medicare UPIN