Basic Information
| Provider Information | |||||||||
| NPI: | 1083644678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILLESPIE | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | RAMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1107 REYNOLDS ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281124351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042898220 | ||||||||
| FaxNumber: | 7042899195 | ||||||||
| Practice Location | |||||||||
| Address1: | 8924 BLAKENEY PROFESSIONAL DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282776660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7047031080 | ||||||||
| FaxNumber: | 7047031090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 200100689 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 89129PE | 05 | NC | MEDICAID |