Provider Demographics
NPI:1538160262
Name:OLALERE, ADEWALE (MD)
Entity type:Individual
Prefix:
First Name:ADEWALE
Middle Name:
Last Name:OLALERE
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 1:3511 W MARKET ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-4444
Mailing Address - Country:US
Mailing Address - Phone:336-522-8999
Mailing Address - Fax:336-522-8998
Practice Address - Street 1:3511 W MARKET ST STE 100
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-4444
Practice Address - Country:US
Practice Address - Phone:336-522-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-00272207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019440810004Medicaid
H68662Medicare UPIN
199494TN3Medicare PIN
060745NWBMedicare PIN