Provider Demographics
NPI:1487686176
Name:JAIN, ASTRID G (MD)
Entity type:Individual
Prefix:
First Name:ASTRID
Middle Name:G
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7810 PROVIDENCE RD
Practice Address - Street 2:STE 105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-2954
Practice Address - Country:US
Practice Address - Phone:704-446-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700297207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891143HMedicaid
NC1487686176Medicaid
NC1143HOtherNCBCBS
SCN00290Medicaid
NC1143HOtherNCBCBS
SCN00290Medicaid
NC2282987BMedicare PIN
NC2282987AMedicare PIN