Provider Demographics
NPI:1033177647
Name:MOSTELLER, GREGORY JAMES (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JAMES
Last Name:MOSTELLER
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:RALEIGH EMERGENCY MEDICINE ASSOCIATES
Mailing Address - Street 2:2500 BLUE RIDGE ROAD, SUITE 417
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607
Mailing Address - Country:US
Mailing Address - Phone:919-787-9097
Mailing Address - Fax:
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307
Practice Address - Country:US
Practice Address - Phone:330-344-1799
Practice Address - Fax:330-253-8293
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073106M207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2060817Medicaid
OH0846164Medicare ID - Type Unspecified
OH2060817Medicaid