Provider Demographics
NPI:1932321585
Name:GAO, PING (PA-C)
Entity Type:Individual
Prefix:
First Name:PING
Middle Name:
Last Name:GAO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 FAIRVIEW DRIVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851
Mailing Address - Country:US
Mailing Address - Phone:757-562-6673
Mailing Address - Fax:757-562-4344
Practice Address - Street 1:102 FAIRVIEW DRIVE
Practice Address - Street 2:SUITE G
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851
Practice Address - Country:US
Practice Address - Phone:757-562-6673
Practice Address - Fax:757-562-4344
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004646363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700E042440OtherBCBS GROUP PIN
MI700E042440OtherBCBS GROUP PIN