1952312183 NPI number — JOHN B GREGORY DPM

Table of content: JOHN B GREGORY DPM (NPI 1952312183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952312183 NPI number — JOHN B GREGORY DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREGORY
Provider First Name:
JOHN
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952312183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 ALICE PECK DAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03766-2900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-443-9572
Provider Business Mailing Address Fax Number:
603-443-9521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 MASCOMA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03766-2661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-443-9572
Provider Business Practice Location Address Fax Number:
603-443-9521
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  0305 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 0305 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1011596 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: U71898 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 03Y007385NH02 . This is a "ANTHEM BCBS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 00068170 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 30363594 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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