Provider Demographics
NPI:1083646293
Name:MILLS, GREGORY DOUGLAS (DPM)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DOUGLAS
Last Name:MILLS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 EAST ROUTE 70
Mailing Address - Street 2:STE L60
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003
Mailing Address - Country:US
Mailing Address - Phone:856-751-3313
Mailing Address - Fax:856-751-8370
Practice Address - Street 1:1930 EAST ROUTE 70
Practice Address - Street 2:STE L60
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:856-751-3313
Practice Address - Fax:856-751-8370
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD1968213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U24483Medicare UPIN
NJ618415Medicare PIN