Provider Demographics
NPI:1467410258
Name:KRIVCHENIA, GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:KRIVCHENIA
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 1:611 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750
Mailing Address - Country:US
Mailing Address - Phone:740-373-8756
Mailing Address - Fax:740-373-0091
Practice Address - Street 1:611 SECOND ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750
Practice Address - Country:US
Practice Address - Phone:740-373-8756
Practice Address - Fax:740-373-0091
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046510207X00000X
WV14610207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000077407OtherBCBS
OH0631365Medicaid
WV00970530000Medicaid
200006583OtherRR MEDICARE
000000117049OtherANTHEM
000000117049OtherANTHEM
KR0584493Medicare ID - Type UnspecifiedMARIETTA
WV00970530000Medicaid
W46510BOtherHEALTH PLAN SISTERSVILLE
WV00970530000Medicaid
W46510OtherHEALTH PLAN MARIETTA
W46510AOtherHLTH PLAN NEWMARTINSVILLE
KR0584496Medicare ID - Type UnspecifiedSISTERSVILLE