Provider Demographics
NPI:1417082322
Name:POKRYWKA, GREGORY STANLEON (MD FACP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:STANLEON
Last Name:POKRYWKA
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5268 NICHOLSON LN
Mailing Address - Street 2:SUITE S
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1009
Mailing Address - Country:US
Mailing Address - Phone:301-231-5055
Mailing Address - Fax:301-231-7217
Practice Address - Street 1:5268 NICHOLSON LN
Practice Address - Street 2:SUITE S
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1009
Practice Address - Country:US
Practice Address - Phone:301-231-5055
Practice Address - Fax:301-231-7217
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2014-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032939207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD399261660Medicaid
MD399261660Medicaid
MD399261600Medicaid