Provider Demographics
NPI:1154323475
Name:MANN, GREGORY A (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:MANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4199 GATEWAY BLVD
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8940
Mailing Address - Country:US
Mailing Address - Phone:812-858-4600
Mailing Address - Fax:812-858-4601
Practice Address - Street 1:4199 GATEWAY BLVD
Practice Address - Street 2:SUITE 2400
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8940
Practice Address - Country:US
Practice Address - Phone:812-858-4600
Practice Address - Fax:812-858-4601
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002391A207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200347520Medicaid
H47801Medicare UPIN
IN200347520Medicaid
IN637080Medicare UPIN