Provider Demographics
NPI:1689876054
Name:LOOMIS, GANDHARI (DO)
Entity Type:Individual
Prefix:DR
First Name:GANDHARI
Middle Name:
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:GANDHARI
Other - Middle Name:
Other - Last Name:WARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:301 LINVILLE ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-7206
Mailing Address - Country:US
Mailing Address - Phone:828-584-2481
Mailing Address - Fax:828-584-8371
Practice Address - Street 1:301 LINVILLE ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-7206
Practice Address - Country:US
Practice Address - Phone:828-584-2481
Practice Address - Fax:828-584-8371
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1689876054Medicaid
NC2403222OtherMEDICARE INDIVIDUAL ID
NCFW0034544OtherDEA
NC2327875GMedicare PIN