Organization
FATADE HEALTH AND MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AYOKUNLE OMOTADE FATADE D.O (PRESIDENT)
(856) 627-8070
Entity
Organization
Contact information
Practice address
255 RIVERSIDE DR, BASSETT, VA 24055-4299
(276) 627-8070
(276) 627-8069
Mailing address
255 RIVERSIDE DR, BASSETT, VA 24055-4299
(276) 627-8070
(276) 627-8069
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0102201991
VA
Other
Enumeration date
03/26/2007
Last updated
08/22/2020
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