Individual
MARTIN KWAKU AGBEMABIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3333 SILAS CREEK PKWY, WINSTON SALEM, NC 27103-3013
(336) 718-7080
(336) 718-9622
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7840
(704) 384-7830
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
200600313
NC
207R00000X
Internal Medicine Physician
32239
SC
208M00000X
Hospitalist Physician
Primary
2006-00313
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
322397
—
SC
05
—
5903499
—
NC
01
—
P00349911
RR MEDICARE
NC
01
—
P00816715
RAILROAD MEDICARE
SC
Enumeration date
05/16/2006
Last updated
12/15/2020
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