Provider Demographics
NPI:1114026804
Name:GROPE DE PROCRURIR GURDJIEFF, P.A.
Entity Type:Organization
Organization Name:GROPE DE PROCRURIR GURDJIEFF, P.A.
Other - Org Name:GPG, PA NEUROLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PHILLP
Authorized Official - Last Name:APOSTOLOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-635-5100
Mailing Address - Street 1:507 POLLOCK STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562
Mailing Address - Country:US
Mailing Address - Phone:252-635-5100
Mailing Address - Fax:
Practice Address - Street 1:507 POLLOCK STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562
Practice Address - Country:US
Practice Address - Phone:252-635-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79012222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1141A BCBSOtherBLUE CROSS BLUE SHIELD
NC130026343OtherRAILROAD MEDICARE
NC891141AMedicaid
NC891141AMedicaid
NC2254762CMedicare PIN