Provider Demographics
NPI:1376958264
Name:NOTTAGE, GREGORY BERNARD
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:BERNARD
Last Name:NOTTAGE
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 1:20 JONES ST # 200
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-3987
Mailing Address - Country:US
Mailing Address - Phone:415-852-5375
Mailing Address - Fax:415-749-2791
Practice Address - Street 1:20 JONES ST # 200
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102
Practice Address - Country:US
Practice Address - Phone:415-852-5375
Practice Address - Fax:415-749-2791
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2019-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00Other00