Provider Demographics
NPI:1073577318
Name:PASTRICK, GREGORY H (MD, PC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:H
Last Name:PASTRICK
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1 SHERIDAN SQ
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7393
Mailing Address - Country:US
Mailing Address - Phone:423-932-4884
Mailing Address - Fax:423-392-4820
Practice Address - Street 1:1 SHERIDAN SQ
Practice Address - Street 2:SUITE 200
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7393
Practice Address - Country:US
Practice Address - Phone:423-932-4884
Practice Address - Fax:423-392-4820
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD31934208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4046491OtherBLUE CROSS BLUE SHIELD
TN4046491OtherBLUE CROSS BLUE SHIELD
TN3712610Medicare PIN