Provider Demographics
NPI:1558565044
Name:MARTYAK, GREGG GABRIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:GABRIEL
Last Name:MARTYAK
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 1:2925 PROFESSIONAL PL
Mailing Address - Street 2:STE 201
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-8133
Mailing Address - Country:US
Mailing Address - Phone:719-260-4767
Mailing Address - Fax:719-260-4765
Practice Address - Street 1:1015 WALNUT ST STE 801
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5005
Practice Address - Country:US
Practice Address - Phone:215-955-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425153207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery