Provider Demographics
NPI:1639387004
Name:AGBEBI, ABAYOMI ADEREMI (MD)
Entity type:Individual
Prefix:
First Name:ABAYOMI
Middle Name:ADEREMI
Last Name:AGBEBI
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 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:704-638-0330
Mailing Address - Fax:704-638-0374
Practice Address - Street 1:911 W HENDERSON ST STE 120
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2700
Practice Address - Country:US
Practice Address - Phone:704-638-0336
Practice Address - Fax:704-638-0374
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD70354207RI0200X
NC2012-00979207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD419971500Medicaid
MD186242Y2ZMedicare PIN
MDP00976301Medicare PIN