Provider Demographics
NPI:1952500423
Name:ADEGOROYE, ADEYINKA ABIMBOLA (MB CHB)
Entity Type:Individual
Prefix:DR
First Name:ADEYINKA
Middle Name:ABIMBOLA
Last Name:ADEGOROYE
Suffix:
Gender:M
Credentials:MB CHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:404 WESTWOOD AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4316
Mailing Address - Country:US
Mailing Address - Phone:336-882-6500
Mailing Address - Fax:336-882-6501
Practice Address - Street 1:404 WESTWOOD AVE STE 105
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4316
Practice Address - Country:US
Practice Address - Phone:336-882-6500
Practice Address - Fax:336-882-6501
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-00955207RN0300X
NY003032174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1952500423Medicaid