Provider Demographics
NPI:1851369334
Name:BAMGBOLA, OLUWATOYIN FATAI (MD)
Entity type:Individual
Prefix:DR
First Name:OLUWATOYIN
Middle Name:FATAI
Last Name:BAMGBOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FATAI
Other - Middle Name:OLUWATOYIN
Other - Last Name:BAMGBOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-713-4500
Mailing Address - Fax:336-713-4501
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-5720
Practice Address - Country:US
Practice Address - Phone:336-713-4500
Practice Address - Fax:336-713-4501
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2200282080P0210X
OK232592080P0210X
NC2025-013882080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06572063Medicaid
LA1025704Medicaid
LA1025704Medicaid
MS06572063Medicaid