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NPI Code Detail

MEDICARE: GINA ELIZABETH MAULDIN PA-C

MEDICARE: GINA ELIZABETH MAULDIN PA-C
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
1363A00000XPhysician Assistant0010-03256NC

Other Identifiers

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

General Provider Information

NPI Number : 1710250527
Entity Type Code : Individual
Provider Name (Legal Business Name) : GINA ELIZABETH MAULDIN PA-C
Provider Business Mailing Address
First Line : 4801 GLENWOOD AVE STE 200
Second Line :
City : RALEIGH
State : NC
Zip : 27612-3857
Country : US
Telephone Number : 919-578-8115
Fax Number : 919-578-6325
Provider Business Practice Location Address
First Line : 4801 GLENWOOD AVE STE 200
Second Line :
City : RALEIGH
State : NC
Zip : 27612-3857
Country : US
Telephone Number : 919-578-8115
Fax Number : 919-578-6325
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2012
Last Update Date : 11/30/2025

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