Provider Demographics
NPI:1558387308
Name:ZERNICH, GREGG S (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:S
Last Name:ZERNICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3950 BRODHEAD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3030
Mailing Address - Country:US
Mailing Address - Phone:724-775-5833
Mailing Address - Fax:724-775-7780
Practice Address - Street 1:3950 BRODHEAD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3030
Practice Address - Country:US
Practice Address - Phone:724-775-5833
Practice Address - Fax:724-775-7780
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS006745L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011810810006Medicaid
E47305Medicare UPIN
PA0011810810006Medicaid