Provider Demographics
NPI:1134136351
Name:ASHLINE, PETER THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:THOMAS
Last Name:ASHLINE
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:PO BOX 60122
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0122
Mailing Address - Country:US
Mailing Address - Phone:828-264-9664
Mailing Address - Fax:828-264-8144
Practice Address - Street 1:175 MARY ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5025
Practice Address - Country:US
Practice Address - Phone:828-264-9664
Practice Address - Fax:828-264-8144
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33937207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11912OtherBCBS
NC891172FMedicaid
NC8911912Medicaid
SCQ33937Medicaid
NC11912OtherBCBS
G31866Medicare UPIN