Provider Demographics
NPI:1083644678
Name:GILLESPIE, RICHARD RAMAS (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:RAMAS
Last Name:GILLESPIE
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 1:8924 BLAKENEY PROFESSIONAL DR # 1
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6660
Mailing Address - Country:US
Mailing Address - Phone:704-703-1080
Mailing Address - Fax:704-289-9195
Practice Address - Street 1:8924 BLAKENEY PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6660
Practice Address - Country:US
Practice Address - Phone:704-703-1080
Practice Address - Fax:704-703-1090
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100689207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129PEMedicaid
2289201Medicare ID - Type Unspecified
H16317Medicare UPIN