Provider Demographics
NPI:1154315398
Name:DEGNAN, GREGORY GERARD VI (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:GERARD
Last Name:DEGNAN
Suffix:VI
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 79777
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0777
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-654-7752
Practice Address - Street 1:3263 PROFFIT RD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-5639
Practice Address - Country:US
Practice Address - Phone:434-654-5575
Practice Address - Fax:434-654-5574
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041387207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF88499Medicare UPIN
VAVVE646AMedicare PIN
VAP01484036Medicare PIN