Provider Demographics
NPI:1992764559
Name:FOLASHADE, CHARLES OLUFEMI (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:OLUFEMI
Last Name:FOLASHADE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 MILTON RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-2437
Mailing Address - Country:US
Mailing Address - Phone:704-535-1019
Mailing Address - Fax:
Practice Address - Street 1:104 RHODES AVE
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-9656
Practice Address - Country:US
Practice Address - Phone:252-794-3042
Practice Address - Fax:252-794-2911
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCM000959Medicaid
MD424L076CMedicare ID - Type Unspecified
MD994643800Medicaid