Provider Demographics
NPI:1558394437
Name:CRISP, GREGORY HANNIBAL (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:HANNIBAL
Last Name:CRISP
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 7432
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27417-0432
Mailing Address - Country:US
Mailing Address - Phone:803-356-2888
Mailing Address - Fax:
Practice Address - Street 1:500 E CORNWALLIS DR STE G
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405
Practice Address - Country:US
Practice Address - Phone:336-763-1101
Practice Address - Fax:866-959-7250
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25487207L00000X, 207LA0401X, 208D00000X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8925721Medicaid
NC25721OtherBCBS OF NC
NC25721OtherBCBS OF NC
C81423Medicare UPIN