MEDICARE: DR. MARY ELIZABETH GAFFNEY D.O.

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	207Q00000X	Family Medicine Physician	9601319	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467569483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ELIZABETH GAFFNEY D.O.

Provider Business Mailing Address
First Line	:	4935 ALBEMARLE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6617
Country	:	US
Telephone Number	:	704-566-6332
Fax Number	:	704-567-9048

Provider Business Practice Location Address
First Line	:	4935 ALBEMARLE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6617
Country	:	US
Telephone Number	:	704-566-6332
Fax Number	:	704-567-9048

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/29/2009

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