Provider Demographics
NPI:1063674174
Name:BOOTH, GREG MARK (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:MARK
Last Name:BOOTH
Suffix:
Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:4231 N WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-3128
Mailing Address - Country:US
Mailing Address - Phone:410-374-9391
Mailing Address - Fax:410-871-7967
Practice Address - Street 1:4231 N WOODS TRL
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-3128
Practice Address - Country:US
Practice Address - Phone:410-374-9391
Practice Address - Fax:410-871-7967
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2024-04-04
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Provider Licenses
StateLicense IDTaxonomies
MDD0077059207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine