Provider Demographics
NPI:1437133626
Name:GILDERSLEEVE, RONALD C (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:GILDERSLEEVE
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 235022
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-5022
Mailing Address - Country:US
Mailing Address - Phone:334-386-2053
Mailing Address - Fax:334-244-1830
Practice Address - Street 1:810 FAIRGROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-9617
Practice Address - Country:US
Practice Address - Phone:334-386-2053
Practice Address - Fax:334-244-1830
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-52027207L00000X
NC9801655207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891185PMedicaid
NC891185PMedicaid
NC2270456AMedicare ID - Type Unspecified