Healthcare Provider Details

I. General information

NPI: 1093129520
Provider Name (Legal Business Name): BABAFEMI SIJABULISO ONABANJO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 05/11/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 FAYETTEVILLE ST
DURHAM NC
27707-2398
US

IV. Provider business mailing address

1301 FAYETTEVILLE ST
DURHAM NC
27707-2398
US

V. Phone/Fax

Practice location:
  • Phone: 919-956-4000
  • Fax: 919-687-4257
Mailing address:
  • Phone: 919-956-4000
  • Fax: 919-687-4257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number270329
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2021-01009
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: