Provider Demographics
NPI:1316033657
Name:GATES, DONNA R (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:R
Last Name:GATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-282-0376
Mailing Address - Fax:336-282-0379
Practice Address - Street 1:3800 ROBERT PORCHER WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2190
Practice Address - Country:US
Practice Address - Phone:336-282-0376
Practice Address - Fax:336-282-0379
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC30643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34947OtherBCBS OF NC
NC36968OtherMEDCOST
NC0103566OtherUHC OF NC
NC16216OtherPARTNERS MEDICARE
NC8934947Medicaid
NC080119592Medicare PIN
NC0103566OtherUHC OF NC
NC36968OtherMEDCOST