Provider Demographics
NPI:1497731699
Name:COPE, GREGORY W (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:W
Last Name:COPE
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:PO BOX 65266
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28265-0266
Mailing Address - Country:US
Mailing Address - Phone:800-377-8721
Mailing Address - Fax:304-523-2241
Practice Address - Street 1:5255 LOUGHBORO RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2695
Practice Address - Country:US
Practice Address - Phone:202-537-4080
Practice Address - Fax:202-537-4588
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD30292207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0005OtherBLUECROSS BLUESHIELD
G51717Medicare UPIN
DCG01564N10Medicare PIN