MEDICARE: MR. ABDUL RASHID GANGOO MD

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	207RI0200X	Infectious Disease Physician	23024	NC
2	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	:	1780641571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ABDUL RASHID GANGOO MD

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

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	01/17/2021

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