Provider Demographics
NPI:1508850827
Name:DEGREGORIO, PAUL G (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:G
Last Name:DEGREGORIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2 PILLSBURY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3502
Mailing Address - Country:US
Mailing Address - Phone:603-228-1104
Mailing Address - Fax:603-228-7061
Practice Address - Street 1:2 PILLSBURY ST STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3549
Practice Address - Country:US
Practice Address - Phone:603-224-2020
Practice Address - Fax:603-228-7061
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10500207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0109320Y0NH01OtherANTHEM NH
NH180035688OtherRAILROAD MEDICARE
NH30200390Medicaid
NH5805901003OtherCIGNA
NH0109320Y0NH01OtherANTHEM NH
NH30200390Medicaid
NH0141110001Medicare NSC