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General NPI Number Information
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NPI Number | 1922726090
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Entity Type | Individual
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Provider Name | MARY OLUWASEUN OLOWERE MD
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Gender | Female
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Dates
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Enumeration Date | 08/16/2022
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 13 MEDICAL PARK DR
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City | LEXINGTON
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State | NC
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Zip | 27292-6768
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Country | US
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Telephone | 336-243-8615
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Fax | 336-724-8624
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Provider Business Mailing Address
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Address Line | 100 KIMEL FOREST DR
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City | WINSTON SALEM
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State | NC
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Zip | 27103-6074
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Country | US
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Telephone | 336-716-2255
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2025-01599
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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