Healthcare Provider Details

I. General information

NPI: 1033746292
Provider Name (Legal Business Name): OLAJUMOKE LADAPO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 12/24/2023
Certification Date: 12/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300A E MCKAY ST
ELIZABETHTOWN NC
28337-9037
US

IV. Provider business mailing address

PO BOX 517
ELIZABETHTOWN NC
28337-0517
US

V. Phone/Fax

Practice location:
  • Phone: 910-862-5500
  • Fax: 910-862-5501
Mailing address:
  • Phone: 910-862-5500
  • Fax: 910-862-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number202301243
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: