Provider Demographics
NPI:1730163163
Name:ATKINS, GREGORY BRANDON (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BRANDON
Last Name:ATKINS
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 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2167963207RC0000X
OH35-089007207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000539490OtherANTHEM
743603OtherBUCKEYE
OH743603OtherBUCKEYE
OHP00374191OtherRAILROAD MEDICARE
7737929OtherAETNA
000000224463OtherUNISON
OH2703711Medicaid
379007OtherWELLCARE
7737929OtherAETNA
743603OtherBUCKEYE
379007OtherWELLCARE
OHP00374191OtherRAILROAD MEDICARE