Provider Demographics
NPI:1164417929
Name:FAUST, GREGORY J (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:FAUST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3640 MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1145
Mailing Address - Country:US
Mailing Address - Phone:413-739-7367
Mailing Address - Fax:413-737-2686
Practice Address - Street 1:3640 MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1145
Practice Address - Country:US
Practice Address - Phone:413-739-7367
Practice Address - Fax:413-737-2686
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA73286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0115328OtherAETNA GROUP NO.
MA073286OtherCONNECTICARE
MA12304OtherHEALTH NEW ENGLAND
MA150662OtherHARVARD PILGRIM
MA180022615OtherRAILROAD MEDICARE
MA0404677003OtherCIGNA
MA073286OtherTUFTS
MAJ10344OtherMA BLUE SHIELD
MA010073286MA01OtherCONNECTICUT BLUE SHIELD
MA0804433OtherUNITED HEALTH CARE
MAP1503588OtherOXFORD HEALTH PLANS
MA150662OtherHARVARD PILGRIM
MAJ10344Medicare PIN