Healthcare Provider Details

I. General information

NPI: 1659570075
Provider Name (Legal Business Name): DAMILOLA OLUWATOSIN JOSEPH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

IV. Provider business mailing address

PO BOX 10467
GREENSBORO NC
27404-0467
US

V. Phone/Fax

Practice location:
  • Phone: 917-626-6304
  • Fax:
Mailing address:
  • Phone: 336-207-7005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2007-01150
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: