Healthcare Provider Details

I. General information

NPI: 1619402021
Provider Name (Legal Business Name): ABISOLA GBEMISOLA BARUWA ETTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABISOLA GBEMISOLA ALUKO

II. Dates (important events)

Enumeration Date: 04/23/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MATTHEWS TOWNSHIP PKWY
MATTHEWS NC
28105-4658
US

IV. Provider business mailing address

200 HAWTHORNE LN
CHARLOTTE NC
28204-2515
US

V. Phone/Fax

Practice location:
  • Phone: 980-302-7010
  • Fax: 980-302-7015
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026-01517
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2026-01517
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: