Provider Demographics
NPI:1699009704
Name:GBADAMOSI, MOBOLANLE O (MD)
Entity type:Individual
Prefix:DR
First Name:MOBOLANLE
Middle Name:O
Last Name:GBADAMOSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4761 WARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4359
Mailing Address - Country:US
Mailing Address - Phone:252-399-2112
Mailing Address - Fax:
Practice Address - Street 1:4761 WARD BLVD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4359
Practice Address - Country:US
Practice Address - Phone:252-399-2112
Practice Address - Fax:252-399-2132
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200901445207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC157VROtherBLUE CROSS BLUE SHIELD
NC3131766OtherUNITED HEALTHCARE
NC5913338Medicaid
NC5913338Medicaid