Provider Demographics
NPI:1528023298
Name:DAMORE, KIRSTEN G (MD)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:G
Last Name:DAMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 744786
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4786
Mailing Address - Country:US
Mailing Address - Phone:704-671-5400
Mailing Address - Fax:704-671-5420
Practice Address - Street 1:640 SUMMIT CROSSING PL STE 200
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2142
Practice Address - Country:US
Practice Address - Phone:704-671-5400
Practice Address - Fax:704-671-5420
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9900810208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1528023298Medicaid
NC1248COtherBCBS
SCN00810Medicaid
SCN00810Medicaid