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DR. OMOTAYO OLUSOLA FASAN MBBS
NPI 1386804409
Internal Medicine - Hematology in Charlotte, NC

Active since June 12, 2008
125 QUEENS RD STE 600, CHARLOTTE, NC 28204(980) 302-6600(980) 302-6605 Get Directions Write a Review

NPPES record last updated: November 18, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Nov 18, 2020, Oct 26, 2020, Dec 26, 2017 (3 updates tracked since 2017).

About Dr. Omotayo Olusola Fasan Mbbs NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. OMOTAYO OLUSOLA FASAN MBBS (NPI 1386804409) is an individual hematology provider in Charlotte, North Carolina, licensed in North Carolina (2013-01292) and active in the NPI registry since June 2008. He maintains a secondary practice location in Danville.

NPPES Registry Identity

NPI1386804409
Entity TypeIndividualMale
Primary Taxonomy207RH0000X
Provider Legal NameDR. OMOTAYO OLUSOLA FASANCredential: MBBS
Location Address125 QUEENS RD STE 600Charlotte, NC 28204-3215
Mailing AddressPo Box 60447Charlotte, NC 28260-0447
Phone(980) 302-6600
Fax(980) 302-6605
Sole ProprietorNo
Enumeration DateJune 12, 2008
Last NPPES UpdateNovember 18, 20203 updates tracked since enumeration
NPPES CertifiedNovember 18, 2020
✔ NPI 1386804409 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyInternal Medicine · HematologyAllopathic & Osteopathic Physicians
Taxonomy Code207RH0000X
Licenses✔ Licensed in NC · 2013-01292✔ Licensed in PA · MT183411✔ Licensed in PA · MD433151
Definition
An internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, clotting disorders, sickle cell disease, hemophilia, leukemia and lymphoma.
Also ListedInternal MedicineTaxonomy 207R00000X · License MT183411 (PA), MD433151 (PA), 2013-01292 (NC)
125 QUEENS RD STE 600, Charlotte, NC 28204
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Secondary Practice Location 1

Location 1100 N Academy AveDanville, PA 17822-2001 · Phone (570) 271-6045 · Fax (570) 271-6542

Other Identifiers 2

MedicaidNC1838SC
Medicaid1386804409NC

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KATHERINE CARRON PHARMD
Pharmacist (Oncology)
125 QUEENS RD STE 600
CHARLOTTE, NC 28204
Mecklenburg County (980) 302-6600
THE PRESBYTERIAN HOSPITAL
Internal Medicine (Hematology & Oncology)
125 QUEENS RD STE 600
CHARLOTTE, NC 28204
Mecklenburg County (980) 302-9304
THE PRESBYTERIAN HOSPITAL
Internal Medicine (Hematology & Oncology)
125 QUEENS RD STE 600
CHARLOTTE, NC 28204
Mecklenburg County (980) 302-9304
MS. MEGHAN DOREN COLLINS PA-C
Physician Assistant
125 QUEENS RD STE 600
CHARLOTTE, NC 28204
Mecklenburg County (980) 302-6600

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Omotayo Fasan's NPI number?

The NPI number for Omotayo Fasan is 1386804409. It was assigned to this individual provider in the NPPES registry on June 12, 2008.

Where is Omotayo Fasan located?

Omotayo Fasan practices at 125 Queens Rd Ste 600, Charlotte, NC 28204. The listed phone number is (980) 302-6600.

What is Omotayo Fasan's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Hematology, with taxonomy code 207RH0000X.

When was this NPI record last updated?

The NPPES record for Omotayo Fasan was last updated on November 18, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.