Provider Demographics
NPI:1588625974
Name:KRAUSE, GREGORY E (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:E
Last Name:KRAUSE
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 1:118 WAVERLY OAKS LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26187-7917
Mailing Address - Country:US
Mailing Address - Phone:304-464-4922
Mailing Address - Fax:
Practice Address - Street 1:800 GRAND CENTRAL MALL STE 11
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-4100
Practice Address - Country:US
Practice Address - Phone:304-916-1270
Practice Address - Fax:304-916-1705
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20217207Y00000X
OH35080785207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2204144Medicaid
WV1802567000Medicaid
OH2204144Medicaid
OHH338581Medicare PIN
WV1802567000Medicaid