Provider Demographics
NPI:1144300062
Name:GRAYSTONE FAMILY HEALTHCARE PA
Entity type:Organization
Organization Name:GRAYSTONE FAMILY HEALTHCARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MDMPH
Authorized Official - Phone:828-326-9355
Mailing Address - Street 1:3511 GRAYSTONE PL
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-8201
Mailing Address - Country:US
Mailing Address - Phone:828-326-9355
Mailing Address - Fax:828-326-9868
Practice Address - Street 1:3511 GRAYSTONE PL
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-8201
Practice Address - Country:US
Practice Address - Phone:828-326-9355
Practice Address - Fax:828-326-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC014V9OtherBLUE CROSS
NC89014V9Medicaid
NC2334934Medicare ID - Type Unspecified