Provider Demographics
NPI:1881657252
Name:GASTON, KRIS (MD)
Entity Type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:GASTON
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1021 MOREHEAD MEDICAL DR
Practice Address - Street 2:STE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2990
Practice Address - Country:US
Practice Address - Phone:980-442-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100873208800000X, 208800000X
TXM5179208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V4805OtherBCBS
NC1881657252Medicaid
NC930108632OtherRAILROAD
SCN0087JMedicaid
NC89129MUMedicaid
NC129MUOtherBCBS
TX8V4805OtherBCBS
NC1881657252Medicaid
NCH53791Medicare UPIN
NC2290430Medicare PIN
NC129MUOtherBCBS
NC89129MUMedicaid
NC2290430BMedicare PIN