DR. OMOTAYO OLUSOLA FASAN (NPI# 1386804409) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386804409 |
| Entity Type | Individual |
| Full Name | DR. OMOTAYO OLUSOLA FASAN |
| Credential | MBBS |
| Practice Address |
1718 E 4th St Ste 807 Charlotte NC 28204-3280 |
| Mailing Address |
Po Box 60447 Charlotte NC 28260-0447 |
| Practice Telephone | 7043163297 |
| Mailing Telephone | 7043847840 |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2020-10-26 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | MT183411 | PA | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | 2013-01292 | NC | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | MD433151 | PA | Allopathic & Osteopathic Physicians |
| N | 207RH0000X |
Internal Medicine Specialization: Hematology |
MT183411 | PA | Allopathic & Osteopathic Physicians |
| Y | 207RH0000X |
Internal Medicine Specialization: Hematology |
2013-01292 | NC | Allopathic & Osteopathic Physicians |
| N | 207RH0000X |
Internal Medicine Specialization: Hematology |
MD433151 | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | NC1838 | 05 | |
| NC | 1386804409 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 100 N Academy Ave, Danville, PA 178222001 | 5702716045 | 5702716542 |
| Street Address |
1718 E 4TH ST STE 807 |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28204-3280 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447424197 | Kimberly Michelle Green | Internal Medicine | 1718 E 4th St Ste 807, Charlotte, NC 28204-3280 | 2008-04-14 |
| 1851953285 | Roseann Marie Barrera | Nurse Practitioner | 1718 E 4th St Ste 807, Charlotte, NC 28204-3280 | 2019-07-06 |
| 1043877574 | Brittany Ann Kober | Nurse Practitioner | 1718 E 4th St Ste 807, Charlotte, NC 28204-3280 | 2019-05-21 |
| 1518520238 | Mallory Brooke Johnson | Nurse Practitioner | 1718 E 4th St Ste 807, Charlotte, NC 28204-3280 | 2019-04-18 |
| 1821597725 | Angeliki Evangelia Raptis | Nurse Practitioner | 1718 E 4th St Ste 807, Charlotte, NC 28204 | 2018-02-06 |
| 1942729439 | Novant Medical Group, Inc | Internal Medicine | 1718 E 4th St Ste 807, Charlotte, NC 28204-3280 | 2017-09-15 |
| 1497192728 | Jenny Park | Nurse Practitioner | 1718 E 4th St Ste 807, Charlotte, NC 28204-3280 | 2013-05-28 |
| 1437499506 | Mary E Dilorenzo | Nurse Practitioner | 1718 E 4th St Ste 807, Charlotte, NC 28204-3280 | 2013-02-26 |
| 1366754954 | Alan P. Zausner Skarbnik | Internal Medicine | 1718 E 4th St Ste 807, Charlotte, NC 28204-3280 | 2010-07-12 |
| 1679806566 | Mary Catherine Meadows | Physician Assistant | 1718 E 4th St Ste 807, Charlotte, NC 28204-3280 | 2009-09-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285263582 | Precise Home Care Service LLC | In Home Supportive Care | 1935 Baxter Street, Unit 101, Charlotte, NC 28204 | 2020-04-07 |
| 1285276253 | Shannon Miller | Counselor | 1432 E Seventh Street, Charlotte, NC 28204 | 2019-10-11 |
| 1194282202 | Madison Joann Mcgarrigle | Behavior Technician | 1401 East 7th Street, Charlotte, NC 28204 | 2019-02-25 |
| 1255802674 | Stacey D. Alston, Dds, Pa | Dentist | 1020 E. 10th St., Suite 1, Charlotte, NC 28204 | 2018-12-11 |
| 1972082097 | Kim Webb Talbert | Nurse Practitioner | Novant Health Presbyterian Medical Center Charlotte, 200 Hawthorne Lane, Charlotte, NC 28204 | 2018-08-09 |
| 1164910535 | Jesse Elijah Roberts | Counselor | 1801 E 5th Street, #208, Charlotte, NC 28204 | 2018-05-01 |
| 1336696848 | Eight Healthcare | Exclusive Provider Organization | 2455 Weddington Ave, 2110, Charlotte, NC 28204 | 2016-09-01 |
| 1225480551 | Kathleen Quintana Bradley | Physician Assistant | 1523 Elizabeth Ave., Suite 200, Charlotte, NC 28204 | 2016-07-11 |
| 1184049777 | Della Franklin | Speech-Language Pathologist | 1021 Morehead Medical Dr Ste 3300, Charlotte, NC 28204 | 2014-02-19 |
| 1225459845 | Healing Arts Medical, Pa | Family Medicine | 335 N. Caswell Rd., Charlotte, NC 28204 | 2013-12-27 |
| Find all providers in zip 28204 | ||||
| Taxonomy Code | 207RH0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Hematology |
| An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, clotting disorders, sickle cell disease, hemophilia, leukemia and lymphoma. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942729439 | Novant Medical Group, Inc | Internal Medicine | 1718 E 4th St Ste 807, Charlotte, NC 28204-3280 | 2017-09-15 |
| 1982038683 | The Charlotte-mecklenburg Hospital Authority | Internal Medicine | 15830 Ballantyne Medical Pl, Suite 200, Charlotte, NC 28277-4653 | 2013-08-29 |
| 1861826562 | The Charlotte-mecklenburg Hospital Authority | Internal Medicine | 101 E W T Harris Blvd, Ste 5500, Charlotte, NC 28262-3485 | 2013-08-29 |
| 1245561554 | Carolinas Hematology-oncology Associates | Internal Medicine | 15830 John J. Delaney Drive, Ste 200, Charlotte, NC 28277-3297 | 2010-01-26 |
| 1417105941 | Shebli Atrash | Internal Medicine | 1021 Morehead Medical Dr, Ste A, Charlotte, NC 28204-2990 | 2008-09-09 |
| 1649447426 | Emiliano Mugnaini | Internal Medicine | 1021 Morehead Medical Dr, Suite A, Charlotte, NC 28204-2990 | 2008-05-12 |
| 1356541445 | Nilay Shah | Internal Medicine | 1021 Morehead Medical Dr, Ste A, Charlotte, NC 28204-2990 | 2007-07-18 |
| 1275679201 | Jonathan Gerber | Internal Medicine | 1021 Morehead Medical Dr, Suite A, Charlotte, NC 28204-2990 | 2007-01-29 |
| 1457412454 | Peter Voorhees | Internal Medicine | 1021 Morehead Medical Dr, Ste A, Charlotte, NC 28204-2990 | 2006-12-13 |
| 1992720494 | Charles Packman | Internal Medicine | 1021 Morehead Medical Dr, Ste A, Charlotte, NC 28204-2990 | 2006-07-13 |
| Find all providers in CHARLOTTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.