Provider Demographics
NPI:1962458943
Name:GASTON WOMEN'S HEALTHCARE, PA
Entity Type:Organization
Organization Name:GASTON WOMEN'S HEALTHCARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELVIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MC
Authorized Official - Phone:704-865-2229
Mailing Address - Street 1:2680 ABERDEEN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0637
Mailing Address - Country:US
Mailing Address - Phone:704-865-2229
Mailing Address - Fax:704-865-2811
Practice Address - Street 1:2680 ABERDEEN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0637
Practice Address - Country:US
Practice Address - Phone:704-865-2229
Practice Address - Fax:704-865-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89012F7Medicaid
NC2344802Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER