Provider Demographics
NPI:1538216544
Name:MORRIS, GREGG LEONARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:GREGG
Middle Name:LEONARD
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 W KYLA MARIE DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5430
Mailing Address - Country:US
Mailing Address - Phone:302-266-6509
Mailing Address - Fax:
Practice Address - Street 1:20 MCMASTER BLVD
Practice Address - Street 2:
Practice Address - City:KEMBLESVILLLE
Practice Address - State:PA
Practice Address - Zip Code:19347
Practice Address - Country:US
Practice Address - Phone:610-255-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051332363A00000X
DEC5-0000544363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE002917D18Medicare PIN