Provider Demographics
NPI:1326728940
Name:GILLESPIE, ERIC RICHARD (PA-C)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:RICHARD
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1540 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-4302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3370 FRONTIS ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5548
Practice Address - Country:US
Practice Address - Phone:336-890-2460
Practice Address - Fax:336-271-7100
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2025-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-13132363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant