Provider Demographics
NPI:1346258837
Name:ANDERSON, GREGORY CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:CHARLES
Last Name:ANDERSON
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 1:6023 HARVARD SQ
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3015
Mailing Address - Country:US
Mailing Address - Phone:412-661-2802
Mailing Address - Fax:412-661-8020
Practice Address - Street 1:6023 HARVARD SQ
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3015
Practice Address - Country:US
Practice Address - Phone:412-661-2802
Practice Address - Fax:412-661-8020
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419588207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019579100001Medicaid
PA0019579100001Medicaid
PAH86415Medicare UPIN