Provider Demographics
NPI:1316553670
Name:BROMLEY, GREGORY A
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:BROMLEY
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 1:14687 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:THORNVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43076-9378
Mailing Address - Country:US
Mailing Address - Phone:740-404-4372
Mailing Address - Fax:
Practice Address - Street 1:10614 OPEN WOODS RD
Practice Address - Street 2:
Practice Address - City:THORNVILLE
Practice Address - State:OH
Practice Address - Zip Code:43076-9398
Practice Address - Country:US
Practice Address - Phone:740-404-4372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care