Provider Demographics
NPI:1780641571
Name:GANGOO, ABDUL RASHID (MD)
Entity Type:Individual
Prefix:MR
First Name:ABDUL
Middle Name:RASHID
Last Name:GANGOO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:810 WEST KING STREET
Mailing Address - Street 2:
Mailing Address - City:KINGS MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28086-2748
Mailing Address - Country:US
Mailing Address - Phone:704-739-8946
Mailing Address - Fax:704-739-6443
Practice Address - Street 1:810 WEST KING STREET
Practice Address - Street 2:
Practice Address - City:KINGS MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28086-2748
Practice Address - Country:US
Practice Address - Phone:704-739-8946
Practice Address - Fax:704-739-6443
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23024207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8934472Medicaid
NC202050Medicare ID - Type Unspecified
C81044Medicare UPIN