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General NPI Number Information
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NPI Number | 1154393171
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Entity Type | Individual
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Provider Name | THEODORE OSARUMWENSE IGBINIGIE MD
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Gender | Male
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 3333 SILAS CREEK PKWY ATTN: IPOF
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City | WINSTON-SALEM
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State | NC
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Zip | 27103-3013
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Country | US
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Telephone | 336-718-7080
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Fax |
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Provider Business Mailing Address
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Address Line | 2085 FRONTIS PLAZA BLVD ATTN: FORSYTH MEDICAL GROUP
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City | WINSTON-SALEM
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State | NC
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Zip | 27103-5614
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Country | US
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Telephone | 336-277-1480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 9500940
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 200100894
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License Number State | NC
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