Fasan, Omotayo Olusola

Fasan, Omotayo Olusola is an individual health care provider with primary practice located at 125 Queens Rd Ste 600 , Charlotte NC 28204-3215. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Hematology. Allopathic & Osteopathic Physicians / Hematology is his primary health care specialty. Fasan, Omotayo Olusola can be contacted via phone (980) 302-6600.

Contact Information

Primary practice address
125 Queens Rd Ste 600 Charlotte NC 28204-3215
Phone: (980) 302-6600
Fax: (980) 302-6605
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 2013-01292 North Carolina
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MD433151 Pennsylvania
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X MT183411 Pennsylvania
Allopathic & Osteopathic Physicians / Hematology 207RH0000X MD433151 Pennsylvania
Allopathic & Osteopathic Physicians / Hematology 207RH0000X MT183411 Pennsylvania
Allopathic & Osteopathic Physicians / Hematology 207RH0000X 2013-01292 North Carolina

Profile Details

NPI number 1386804409
LBN Legal business name Fasan, Omotayo Olusola
Credentials MBBS
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 12th, 2008
Last updated Nov 18th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1386804409 NPPES
South Carolina MEDICAID NC1838
South Carolina MEDICAID 1386804409

Popular Providers