Provider Demographics
NPI:1164415972
Name:GRESH, JOHN H (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:GRESH
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 1:4815 LIBERTY AVE
Mailing Address - Street 2:SUITE 448
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-2156
Mailing Address - Country:US
Mailing Address - Phone:412-682-6800
Mailing Address - Fax:412-682-2036
Practice Address - Street 1:4815 LIBERTY AVE
Practice Address - Street 2:SUITE 448
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-2156
Practice Address - Country:US
Practice Address - Phone:412-682-6800
Practice Address - Fax:412-682-2036
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA000827L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00478615Medicare PIN
PA121415N79Medicare PIN
P78743Medicare UPIN
PA66099Medicare PIN