Provider Demographics
NPI:1427033455
Name:GRYN, JEFFREY FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:FRANCIS
Last Name:GRYN
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 1:1100 MEADE ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-3169
Mailing Address - Country:US
Mailing Address - Phone:570-342-3675
Mailing Address - Fax:570-342-3316
Practice Address - Street 1:1100 MEADE ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512
Practice Address - Country:US
Practice Address - Phone:570-342-3675
Practice Address - Fax:570-342-3316
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029694E207RH0000X, 207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
84400692OtherCIGNA
PA1508424OtherGATEWAY
PA000927308OtherION HEALTH MEDICAID HMO
PA0009273080006Medicaid
3503772OtherAETNA PIN FOR HMOS
000000152639OtherUNISON MEDPLUS
C34153OtherHEALTH AMERICA PIN
OH000000351803OtherANTHEM BCBS
PA0009273080005Medicaid
OH2455418Medicaid
4356942OtherAETNA PIN FOR PPOS
P0096493OtherRAILROAD MEDICARE
GR438116OtherHIGHMARK BCBS PIN
PA1508424OtherGATEWAY
OH2455418Medicaid