Provider Demographics
NPI:1861455651
Name:GINGRAS, JEANNINE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:LOUISE
Last Name:GINGRAS
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 1:6207 PARK SOUTH DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3267
Mailing Address - Country:US
Mailing Address - Phone:704-944-0562
Mailing Address - Fax:704-944-0563
Practice Address - Street 1:6207 PARK SOUTH DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3267
Practice Address - Country:US
Practice Address - Phone:704-944-0562
Practice Address - Fax:704-944-0563
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27192207RS0012X, 2080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC51322OtherBCBS
SCN27192Medicaid
NCP00919755OtherRAILROAD MEDICARE
NC8951322Medicaid
NC8951322Medicaid
NCP00919755OtherRAILROAD MEDICARE