Organization
ONSLOW ONCOLOGY PRACTICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ADESOLA AWOMOLO MD (PHYSICIAN)
(910) 455-5511
Entity
Organization
Contact information
Practice address
221 MEMORIAL DRIVE, JACKSONVILLE, NC 28546-6333
(910) 455-5511
(910) 455-4919
Mailing address
PO BOX 12234, JACKSONVILLE, NC 28546-2234
(910) 455-5511
(910) 455-4919
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
200101004
NC
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
200101004
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1292U
BLUE CROSS & BLUE SHIELD
NC
01
—
2292263C
INDIVIDUAL MEDICARE PIN
NC
05
—
891292U
—
NC
Enumeration date
09/27/2006
Last updated
02/04/2010
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