Provider Demographics
NPI:1033107701
Name:ALBERS, GREGG R (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:R
Last Name:ALBERS
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 1:1610 LANGHORNE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-3118
Mailing Address - Country:US
Mailing Address - Phone:434-384-6373
Mailing Address - Fax:
Practice Address - Street 1:2811 LINKHORNE DR
Practice Address - Street 2:SUITE A
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-3321
Practice Address - Country:US
Practice Address - Phone:434-384-1581
Practice Address - Fax:434-384-5609
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035356207Q00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005644330Medicaid
VA005644330Medicaid
VAC36628Medicare UPIN