Provider Demographics
NPI:1225808967
Name:MAIRS, GREG
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:MAIRS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-1483
Mailing Address - Country:US
Mailing Address - Phone:802-388-6751
Mailing Address - Fax:802-388-3108
Practice Address - Street 1:89 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1483
Practice Address - Country:US
Practice Address - Phone:802-388-6751
Practice Address - Fax:802-388-3108
Is Sole Proprietor?:No
Enumeration Date:2024-01-04
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker