Individual
EMMANUEL ADEGOKE FADEYI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-7595
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-7595
Taxonomy
Speciality
Code
Description
License number
State
207ZB0001X
Blood Banking & Transfusion Medicine Physician
2007-01579
NC
207ZC0006X
Clinical Pathology Physician
Primary
2007-01579
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1464T
BCBS
NC
05
—
5908038
—
NC
Enumeration date
09/25/2007
Last updated
01/09/2012
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