Provider Demographics
NPI:1033272752
Name:GAVIGAN, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:GAVIGAN
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:CHOWAN OBSTETRICS AND GYNECOLOGY
Mailing Address - Street 2:105 MARK DRIVE
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932
Mailing Address - Country:US
Mailing Address - Phone:252-482-2134
Mailing Address - Fax:252-482-5529
Practice Address - Street 1:105 MARK DR
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-1704
Practice Address - Country:US
Practice Address - Phone:252-482-2134
Practice Address - Fax:252-482-5529
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200358207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131EYMedicaid
NC89131EYMedicaid
NCH63782Medicare UPIN