Healthcare Provider Details

I. General information

NPI: 1699009704
Provider Name (Legal Business Name): MOBOLANLE O GBADAMOSI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E C ST
BUTNER NC
27509-2530
US

IV. Provider business mailing address

1600 E C ST
BUTNER NC
27509-2530
US

V. Phone/Fax

Practice location:
  • Phone: 919-575-1890
  • Fax: 919-575-1637
Mailing address:
  • Phone: 919-575-1890
  • Fax: 919-575-1637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number200901445
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: