Provider Demographics
NPI:1316372956
Name:PANE, GREGG ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:ANTHONY
Last Name:PANE
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:PO BOX 8207
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22106-8207
Mailing Address - Country:US
Mailing Address - Phone:703-785-7274
Mailing Address - Fax:
Practice Address - Street 1:1228 INGLESIDE AVE
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-2817
Practice Address - Country:US
Practice Address - Phone:703-785-7274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052137207P00000X
DCMD0351772083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine