Provider Demographics
NPI:1609971068
Name:GILLESPIE, MICHAEL JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:GILLESPIE
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 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8749
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:
Practice Address - Street 1:110 FIELDS DR
Practice Address - Street 2:SUITE A
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5066
Practice Address - Country:US
Practice Address - Phone:919-777-9005
Practice Address - Fax:919-708-1550
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-00210207RC0000X
NC200400210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00803617OtherPALMETTO GBA (R/R MCR)
224790OtherMEDCOST
NC13633OtherBC/BS NC
SCG0021MOtherSC MEDICAID
NC8913633Medicaid
220002370OtherFIRSTCAROLINACARE, INC
3144172OtherCIGNA HEALTHCARE
220002370OtherFIRSTCAROLINACARE, INC
NCI11681Medicare UPIN