Provider Demographics
NPI:1740286178
Name:ASTLE, NANCY J (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:ASTLE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1072 X RAY DR STE B
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7488
Mailing Address - Country:US
Mailing Address - Phone:704-671-1094
Mailing Address - Fax:704-671-1095
Practice Address - Street 1:13539 REESE BLVD W STE B
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7961
Practice Address - Country:US
Practice Address - Phone:704-892-4878
Practice Address - Fax:704-892-7453
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2023-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9400198207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01056OtherBCBS NC
070007019AOtherRAILROAD MEDICARE
2197755Medicare ID - Type Unspecified
E38564Medicare UPIN