=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316993462
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADEDIJI OSINLOYE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2006
-----------------------------------------------------
Last Update Date | 09/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10922 S TRYON ST SUITE A
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28273-4151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-368-7540
-----------------------------------------------------
Fax | 704-368-7541
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10922 S TRYON ST SUITE A
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28273-4151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-368-7540
-----------------------------------------------------
Fax | 704-368-7541
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 2004-01293
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 31254
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 200401293
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------