Provider Demographics
NPI:1225070972
Name:FREY, GREGORY A (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:FREY
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 1:4700 SMITH RD
Mailing Address - Street 2:SUITE L
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2787
Mailing Address - Country:US
Mailing Address - Phone:513-366-4000
Mailing Address - Fax:513-366-4001
Practice Address - Street 1:4700 SMITH RD
Practice Address - Street 2:SUITE L
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2787
Practice Address - Country:US
Practice Address - Phone:513-366-4000
Practice Address - Fax:513-366-4001
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35-04-1692208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00013189OtherRAILROAD MEDICARE
KY64206576Medicaid
OH0276946Medicaid
OH0550836Medicaid
KY3440011127OtherRAILROAD MEDICARE
KY3627Medicare PIN
OHP00013189OtherRAILROAD MEDICARE
KY64206576Medicaid
OH0276946Medicaid
KY362704Medicare PIN
OH0550836Medicaid