Provider Demographics
NPI:1457373565
Name:GORE, ASHWINI PRABHAKAR (MD)
Entity Type:Individual
Prefix:
First Name:ASHWINI
Middle Name:PRABHAKAR
Last Name:GORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 SHERATON BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210
Mailing Address - Country:US
Mailing Address - Phone:478-746-8626
Mailing Address - Fax:478-746-0491
Practice Address - Street 1:265 SHERATON BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210
Practice Address - Country:US
Practice Address - Phone:478-746-8626
Practice Address - Fax:478-746-0491
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31585207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2859838000OtherBCBS
PA2088939OtherHIGHMARK BLUE SHIELD
PA1019259910001Medicaid
PA1019259910002Medicaid
PAP00472093Medicare PIN
PA2859838000OtherBCBS