Provider Demographics
NPI:1508858515
Name:STOCKFISH, GREGORY S (DPM,FACFAS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:STOCKFISH
Suffix:
Gender:M
Credentials:DPM,FACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 COPELAND MILL RD
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8977
Mailing Address - Country:US
Mailing Address - Phone:614-891-2828
Mailing Address - Fax:614-891-5411
Practice Address - Street 1:575 COPELAND MILL RD
Practice Address - Street 2:SUITE 2F
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8977
Practice Address - Country:US
Practice Address - Phone:614-891-2828
Practice Address - Fax:614-891-5411
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002387213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0707702Medicaid
OH311795350030OtherCARESOURCE
OH000000211119OtherANTHEM
OH4649800001OtherADMINASTAR
OH4778110001OtherADMINASTAR
OH030507736028OtherCARESOURCE
OH480035261OtherRAILROAD MEDICARE
OH000000273180OtherANTHEM
OH480032425OtherRAILROAD MEDICARE
OH480032425OtherRAILROAD MEDICARE
OHST0601406Medicare PIN
OH000000211119OtherANTHEM