Provider Demographics
NPI:1578506143
Name:ADEY, GREGORY S (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:ADEY
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 1:144 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3776
Mailing Address - Country:US
Mailing Address - Phone:207-879-3000
Mailing Address - Fax:
Practice Address - Street 1:195 FORE RIVER PARKWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2715
Practice Address - Country:US
Practice Address - Phone:207-523-5901
Practice Address - Fax:207-523-5902
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016729208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME1379Medicare ID - Type Unspecified
MEH91446Medicare UPIN