Provider Demographics
NPI:1114920576
Name:DONALDSON, GREGG C (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:C
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 SETON DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1818
Mailing Address - Country:US
Mailing Address - Phone:301-722-3111
Mailing Address - Fax:301-722-5135
Practice Address - Street 1:912 SETON DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1818
Practice Address - Country:US
Practice Address - Phone:301-722-3111
Practice Address - Fax:301-722-5135
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD766241601Medicaid
893415OtherMDIPA/OPTIMUM CHOICE
W3990008OtherBCBS FEDERAL
PA0011509001Medicaid
WV2000220000Medicaid
2100999OtherUNITED HEALTHCARE
990015534OtherRAILROAD MEDICARE
2117570OtherCIGNA
528302-02OtherBCBS POS
P14964OtherBCBS POS PRIMARY
990015534OtherRAILROAD MEDICARE