Provider Demographics
NPI:1548464290
Name:ORNELLA, GREGORY A (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:ORNELLA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-451-5855
Mailing Address - Fax:502-479-1425
Practice Address - Street 1:PO BOX 32310
Practice Address - Street 2:FORD MOTOR COMPANY
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40232-2310
Practice Address - Country:US
Practice Address - Phone:502-429-2228
Practice Address - Fax:502-429-2960
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
KY263012083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYAPPLIEDMedicare UPIN