Provider Demographics
NPI:1699730721
Name:OLAJIDE, OLUDAMILOLA ABIDEMI (MD)
Entity type:Individual
Prefix:
First Name:OLUDAMILOLA
Middle Name:ABIDEMI
Last Name:OLAJIDE
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 1:4420 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7505
Mailing Address - Country:US
Mailing Address - Phone:919-784-6818
Mailing Address - Fax:919-784-6826
Practice Address - Street 1:4420 LAKE BOONE TRL
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7505
Practice Address - Country:US
Practice Address - Phone:919-784-6818
Practice Address - Fax:919-784-6826
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400930207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903626Medicaid
NC5903626Medicaid
I52788Medicare UPIN
BO8994053OtherDEA