Provider Demographics
NPI:1952695397
Name:BENJAMIN O. AKIWUMI, MD
Entity type:Organization
Organization Name:BENJAMIN O. AKIWUMI, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:OLUFEMI
Authorized Official - Last Name:AKIWUMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-300-9220
Mailing Address - Street 1:PO BOX 1579
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-1579
Mailing Address - Country:US
Mailing Address - Phone:910-300-9220
Mailing Address - Fax:910-300-9270
Practice Address - Street 1:105 W COURTHOUSE AVE
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-0000
Practice Address - Country:US
Practice Address - Phone:910-300-9220
Practice Address - Fax:910-300-9270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900005207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917616Medicaid
NC9900005OtherLICENSE
NC9900005OtherLICENSE
NCG91006Medicare UPIN