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:
Health care specialties
| Specialty | Code | License # | 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 6 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1386804409 | NPPES |
| South Carolina | MEDICAID | NC1838 | |
| South Carolina | MEDICAID | 1386804409 |
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