Provider Demographics
NPI:1265475198
Name:GREGORIO, MARIA GIA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:GIA
Last Name:GREGORIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10859 NW SUPREME CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-8816
Mailing Address - Country:US
Mailing Address - Phone:503-641-6429
Mailing Address - Fax:
Practice Address - Street 1:10859 NW SUPREME CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-8816
Practice Address - Country:US
Practice Address - Phone:503-641-6429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28253207RX0202X
AL26528207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051555699Medicaid
AL051555699Medicaid
AL051555699GREMedicare ID - Type Unspecified