MEDICARE: LAUREN BROOKE GANDHI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	9600540	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00457712	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9600540	OTHER	NC	MEDICAL LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447257092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN BROOKE GANDHI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 751803
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1803
Country	:	US
Telephone Number	:	336-774-3740
Fax Number	:	336-774-3780

Provider Business Practice Location Address
First Line	:	3333 BROOKVIEW HILLS BLVD
Second Line	:	STE 204
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5661
Country	:	US
Telephone Number	:	336-774-3740
Fax Number	:	336-774-3780

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	10/28/2020

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Directions to “ LAUREN BROOKE GANDHI M.D.” Practice Location

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