Provider Demographics
NPI:1386674760
Name:GREGORY H CRISP, MD, PA
Entity Type:Organization
Organization Name:GREGORY H CRISP, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGROY
Authorized Official - Middle Name:HANNIBAL
Authorized Official - Last Name:CRISP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-538-7180
Mailing Address - Street 1:PO BOX 7432
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27417-0432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1236 HUFFMAN MILL RD
Practice Address - Street 2:SUITE 2000
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-538-7180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2169365EMedicare PIN