Provider Demographics
NPI:1548706799
Name:MARTIN G GREGORIO MD AND ASSOCIATES PC
Entity type:Organization
Organization Name:MARTIN G GREGORIO MD AND ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCPEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-934-1900
Mailing Address - Street 1:1500 VILLAGE RUN ROAD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090
Mailing Address - Country:US
Mailing Address - Phone:724-934-1900
Mailing Address - Fax:724-934-3388
Practice Address - Street 1:1500 VILLAGE RUN RD
Practice Address - Street 2:SUITE 308
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-6316
Practice Address - Country:US
Practice Address - Phone:724-934-1900
Practice Address - Fax:724-934-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036862E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB41004Medicare UPIN
E23181Medicare UPIN