Provider Demographics
NPI:1700097193
Name:BINGHAM, GINA LEANNE (MD)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:LEANNE
Last Name:BINGHAM
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 1:803 MEYERS BAKER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-3039
Mailing Address - Country:US
Mailing Address - Phone:606-878-3240
Mailing Address - Fax:606-878-4308
Practice Address - Street 1:803 MEYERS BAKER RD
Practice Address - Street 2:STE 200
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3039
Practice Address - Country:US
Practice Address - Phone:606-878-3240
Practice Address - Fax:606-878-4308
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP246207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0736409Medicare PIN
KY0873411Medicare PIN
KYOTH000Medicare UPIN
KY0076917Medicare PIN
KY0374013Medicare PIN
KY0230815Medicare PIN