Dr. Omotayo Olusola Fasan
Internist Hematologist and 2 more
125 Queens Rd Ste 600
Charlotte
, North Carolina 28204-3215
Dr. Omotayo Olusola Fasan
Internist Hematologist and 2 more
125 Queens Rd Ste 600
Charlotte
, North Carolina 28204-3215
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About
Features
Specialties
- Internist
- Hematologist
Languages spoken
- English
Location
First Address
- Dr. Omotayo Olusola Fasan
- Po Box 60447
- Charlotte, NC
- Zip : 28260-0447
- Phone :
Second Address
- Dr. Omotayo Olusola Fasan
- 125 Queens Rd Ste 600
- Charlotte, NC
- Zip : 28204-3215
- Fax : (980) 302-6605
- Phone : (980) 302-6600
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FAQs
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What type of doctor is Dr. Omotayo Olusola Fasan
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Is Dr. Omotayo Olusola Fasan a sole practitioner?
Is Dr. Omotayo Olusola Fasan accepting new patients?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207R00000X | Internist | 2013-01292 | NC |
| N | 111NI0900X | Internist | 2013-01292 | NC |
| N | 207R00000X | Internist | MD433151 | PA |
| N | 111NI0900X | Internist | MD433151 | PA |
| N | 207R00000X | Internist | MT183411 | PA |
| N | 111NI0900X | Internist | MT183411 | PA |
| Y | 207RH0000X | Hematologist | 2013-01292 | NC |
| N | 207RH0000X | Hematologist | MD433151 | PA |
| N | 207RH0000X | Hematologist | MT183411 | PA |
National Provider Identifier
| NPI | 1386804409 |
|---|---|
| Provider Name | Dr. Omotayo Olusola Fasan |
| First Address | Charlotte, NC 28260-0447 |
| Second Address | Charlotte, NC 28204-3215 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 12/06/2008 |
| Last Update Date | 18/11/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 1386804409 | (05) | NC |
| NC1838 | (05) | SC |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.