Provider Demographics
NPI:1538192984
Name:ACKROYD, GREGORY T (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:T
Last Name:ACKROYD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5000
Mailing Address - Country:US
Mailing Address - Phone:707-525-9616
Mailing Address - Fax:707-526-2358
Practice Address - Street 1:585 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5000
Practice Address - Country:US
Practice Address - Phone:707-525-9616
Practice Address - Fax:707-526-2358
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA843482084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901340Medicaid
NCI34589Medicare UPIN
NC2043681Medicare ID - Type Unspecified