Provider Demographics
NPI:1902912397
Name:ASEMOTA, OGIEMWONYI ELEKHUOBA (MD)
Entity Type:Individual
Prefix:
First Name:OGIEMWONYI
Middle Name:ELEKHUOBA
Last Name:ASEMOTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4433
Mailing Address - Country:US
Mailing Address - Phone:910-484-4233
Mailing Address - Fax:910-484-2990
Practice Address - Street 1:509 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4433
Practice Address - Country:US
Practice Address - Phone:910-484-4233
Practice Address - Fax:910-484-2990
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700454208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891066JMedicaid
NC891066JMedicaid