MEDICARE: ABDUL R GANGOO MD PA

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	207R00000X	Internal Medicine Physician	23024	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	:	1417262395
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABDUL R GANGOO MD PA

Provider Business Mailing Address
First Line	:	810 W KING ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-2748
Country	:	US
Telephone Number	:	704-739-8946
Fax Number	:	704-739-6443

Provider Business Practice Location Address
First Line	:	810 W KING ST
Second Line	:
City	:	KINGS MOUNTAIN
State	:	NC
Zip	:	28086-2748
Country	:	US
Telephone Number	:	704-739-8946
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ABDUL RASHID GANGOO
Credential	:	MD
Telephone Number	:	704-739-8946

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	01/17/2021

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