Provider Demographics
NPI:1063472801
Name:GINGRICH, TINA M (MD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:GINGRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:FURFARO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2358
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-8169
Mailing Address - Country:US
Mailing Address - Phone:214-295-8675
Mailing Address - Fax:866-207-2534
Practice Address - Street 1:4510 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1650
Practice Address - Country:US
Practice Address - Phone:214-295-8675
Practice Address - Fax:866-207-2534
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9162207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6004798OtherBCBS ILLINOIS
IL036087255Medicaid
MO12646OtherBLUE SHIELD MISSOURI
IL160041360OtherRR MEDICARE
IL371324674OtherTAX ID
IL371324674OtherTAX ID
ILL66483Medicare PIN