Provider Demographics
NPI:1174561187
Name:LAWAL, OLUJIDE G (MD)
Entity type:Individual
Prefix:DR
First Name:OLUJIDE
Middle Name:G
Last Name:LAWAL
Suffix:
Gender:M
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:PO BOX 843232
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3232
Mailing Address - Country:US
Mailing Address - Phone:910-895-7227
Mailing Address - Fax:910-895-7089
Practice Address - Street 1:106 PHYSICIANS PARK DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-5204
Practice Address - Country:US
Practice Address - Phone:910-895-7227
Practice Address - Fax:910-895-7089
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001193207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127W5Medicaid
NC2281260DMedicare PIN
G04529Medicare UPIN
NC89127W5Medicaid