Provider Demographics
NPI:1801109590
Name:GINGRAS SLEEP MEDICINE PA
Entity type:Organization
Organization Name:GINGRAS SLEEP MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GINGRAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-944-0562
Mailing Address - Street 1:6207 PARK SOUTH DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3267
Mailing Address - Country:US
Mailing Address - Phone:704-944-0562
Mailing Address - Fax:704-944-0563
Practice Address - Street 1:6207 PARK SOUTH DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3267
Practice Address - Country:US
Practice Address - Phone:704-944-0562
Practice Address - Fax:704-944-0563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC023N8OtherBCBS
SCNPB395Medicaid
NCDR3092OtherRAILROAD MEDICARE
NC5915209Medicaid
NCDR3092OtherRAILROAD MEDICARE