Provider Demographics
NPI:1467569483
Name:GAFFNEY, MARY ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:GAFFNEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4935 ALBEMARLE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-6617
Mailing Address - Country:US
Mailing Address - Phone:704-566-6332
Mailing Address - Fax:704-567-9048
Practice Address - Street 1:4935 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6617
Practice Address - Country:US
Practice Address - Phone:704-566-6332
Practice Address - Fax:704-567-9048
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2009-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9601319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8934348Medicaid
F51473Medicare UPIN
NC8934348Medicaid