Provider Demographics
NPI:1932324985
Name:ADEROJU, ADEMOLA OLUBUSOLA (MD)
Entity Type:Individual
Prefix:
First Name:ADEMOLA
Middle Name:OLUBUSOLA
Last Name:ADEROJU
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:PO BOX 602658
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2658
Mailing Address - Country:US
Mailing Address - Phone:336-716-2011
Mailing Address - Fax:
Practice Address - Street 1:1404 WILLOW LN
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3584
Practice Address - Country:US
Practice Address - Phone:336-903-6820
Practice Address - Fax:336-903-6821
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01398207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910809Medicaid
NCNCE698AMedicare PIN