Provider Demographics
NPI:1871156570
Name:AWE, MOFOLUWAKE OMOLADE (MD)
Entity type:Individual
Prefix:DR
First Name:MOFOLUWAKE
Middle Name:OMOLADE
Last Name:AWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:91 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-9590
Mailing Address - Country:US
Mailing Address - Phone:252-451-3100
Mailing Address - Fax:252-937-3106
Practice Address - Street 1:91 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-9590
Practice Address - Country:US
Practice Address - Phone:252-451-3100
Practice Address - Fax:252-937-3106
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2022-01354208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program