MEDICARE: NIA LASHAE GILMORE 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1841133097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIA LASHAE GILMORE MD

Provider Business Mailing Address
First Line	:	3436 BRIARCLIFF DR APT W
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5416
Country	:	US
Telephone Number	:	910-587-3694
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 W MARKHAM ST # 602
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-7101
Country	:	US
Telephone Number	:	501-526-7732
Fax Number	:

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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