Provider Demographics
NPI:1275532921
Name:GREGORY, DAVID S (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:GREGORY
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 1:1314 PETERS CREEK RD NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017-2500
Mailing Address - Country:US
Mailing Address - Phone:540-562-5700
Mailing Address - Fax:540-562-4278
Practice Address - Street 1:1314 PETERS CREEK RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-2500
Practice Address - Country:US
Practice Address - Phone:540-562-5700
Practice Address - Fax:540-562-4278
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005625599Medicaid
102874OtherANTHEM PROVIDER NUMBER
320665OtherANTHEM PROVIDER NUMBER
56-2559-9OtherVA PREMIER PROVIDER NUMBE
41820OtherSENTARA/OPTIMA PROVIDER N
541457983OtherTRICARE PROVIDER NUMBER
56162OtherMEDCOST PROVIDER NUMBER
248975OtherSOUTHERN HEALTH PROVIDER
700011705OtherCIGNA PROVIDER NUMBER
VA010141770Medicaid
541457983OtherPCHP PROVIDER NUMBER
5527697002OtherCIGNA PROVIDER NUMBER
248975OtherSOUTHERN HEALTH PROVIDER
VA005625599Medicaid
080176097Medicare PIN