Provider Demographics
NPI:1730242397
Name:PAPA, GREGORY (DO)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:PAPA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3620 N DUPONT HWY
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-6316
Mailing Address - Country:US
Mailing Address - Phone:302-658-5803
Mailing Address - Fax:302-652-2531
Practice Address - Street 1:3620 N DUPONT HWY
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-6316
Practice Address - Country:US
Practice Address - Phone:302-658-5803
Practice Address - Fax:302-652-2531
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0002649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000197903Medicaid
DEF04420Medicare UPIN
DE128279Medicare PIN