Provider Demographics
NPI:1093769515
Name:NEWKIRK, GREGORY S (PA-C)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:NEWKIRK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-354-7785
Mailing Address - Fax:513-354-7651
Practice Address - Street 1:500 E BUSINESS WAY STE A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-2374
Practice Address - Country:US
Practice Address - Phone:513-354-3700
Practice Address - Fax:513-354-3705
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1807363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH477802OtherOH MEDICARE
OH0068097OtherMEDICAID
OH564784OtherWELLCARE
OH0068097OtherMEDICAID
OH1093769515OtherMEDICAL MUTUAL
OH95005690Medicaid
OH680903OtherANTHEM
OH1132517OtherGATEWAY HEALTH
OH763302/714266OtherBUCKEYE MEDICAID/MEDICARE
OH1132517OtherGATEWAY HEALTH