Provider Demographics
NPI:1528059920
Name:AJAO, OLUFOLARIN AKANFE (MD)
Entity type:Individual
Prefix:DR
First Name:OLUFOLARIN
Middle Name:AKANFE
Last Name:AJAO
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 1:2664 COURT DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-1449
Mailing Address - Country:US
Mailing Address - Phone:704-861-9030
Mailing Address - Fax:704-833-1234
Practice Address - Street 1:2664 COURT DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-1449
Practice Address - Country:US
Practice Address - Phone:704-861-9030
Practice Address - Fax:704-833-1234
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95-01167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910992Medicaid
NCG15681Medicare UPIN
NC2225180CMedicare ID - Type Unspecified