Provider Demographics
NPI:1922051929
Name:GABRIEL, TORRI D (PA)
Entity Type:Individual
Prefix:
First Name:TORRI
Middle Name:D
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TORRIE
Other - Middle Name:LA'SHANA
Other - Last Name:DILLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:704-316-1050
Mailing Address - Fax:704-316-1051
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:SUITE 175
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1100
Practice Address - Country:US
Practice Address - Phone:704-316-1050
Practice Address - Fax:704-316-1051
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102652363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101729Medicaid
NC2751513BMedicare PIN
NC8101729Medicaid
NCS76846Medicare UPIN