Provider Demographics
NPI:1811967771
Name:GAINES, ASHLEY PENDLETON (MD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:PENDLETON
Last Name:GAINES
Suffix:
Gender:M
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5427 NC HIGHWAY 49 S
Practice Address - Street 2:STE 102
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7408
Practice Address - Country:US
Practice Address - Phone:704-454-7360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200356207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132GFMedicaid
NCP00137174OtherRAILROAD MCR
NC132GFOtherBCBS ID
NCD4899OtherMEDCOST
NC9991799OtherCIGNA
NC7092354OtherAETNA ID
NC232009OtherMEDICARE OTHER
NC800998OtherPARTNERS MCR CHOICE
NC2124487OtherMAMSI
NC132GFOtherBCBS ID
NCD4899OtherMEDCOST
NC800998OtherPARTNERS MCR CHOICE