Basic Information
| Provider Information | |||||||||
| NPI: | 1134136351 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASHLINE | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60122 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282649664 | ||||||||
| FaxNumber: | 8282648144 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 MARY ST | ||||||||
| Address2: | |||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286075025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282649664 | ||||||||
| FaxNumber: | 8282648144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 08/26/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 33937 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 11912 | 01 | NC | BCBS | OTHER | 891172F | 05 | NC | MEDICAID | 8911912 | 05 | NC | MEDICAID | Q33937 | 05 | SC | MEDICAID |