Provider Demographics
NPI:1316993462
Name:OSINLOYE, ADEDIJI (MD)
Entity type:Individual
Prefix:
First Name:ADEDIJI
Middle Name:
Last Name:OSINLOYE
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 1:10922 S TRYON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4151
Mailing Address - Country:US
Mailing Address - Phone:704-368-7540
Mailing Address - Fax:704-368-7541
Practice Address - Street 1:10922 S TRYON ST
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4151
Practice Address - Country:US
Practice Address - Phone:704-368-7540
Practice Address - Fax:704-368-7541
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-01293207P00000X
SC31254207R00000X
NC200401293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13827OtherBLUE CROSS BLUE SHIELD
NC5900627Medicaid
26-2140977OtherTRICARE
NC26-2140977OtherUNITED HEALTHCARE
NC26-2140977OtherBCBS NC
26-2140977OtherAETNA
26-21400977OtherPACIFICARE
NC5900627Medicaid
NCPENDINGMedicare ID - Type Unspecified