Provider Demographics
NPI:1083645972
Name:PEARSON, GREGG A (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:A
Last Name:PEARSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:19 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4180
Mailing Address - Country:US
Mailing Address - Phone:609-561-5900
Mailing Address - Fax:609-561-8989
Practice Address - Street 1:369S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:NJ
Practice Address - Zip Code:08089-1741
Practice Address - Country:US
Practice Address - Phone:609-561-5900
Practice Address - Fax:609-561-8989
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB72474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH49140Medicare UPIN
NJ051428Medicare PIN