Provider Demographics
NPI:1588639975
Name:CLIFFORD, GREGG R (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:R
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:301 RIVERVIEW AVE
Mailing Address - Street 2:STE 900
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-252-9300
Mailing Address - Fax:757-252-9301
Practice Address - Street 1:301 RIVERVIEW AVE
Practice Address - Street 2:STE 900
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-252-9300
Practice Address - Fax:757-252-9301
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101037676207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006026982Medicaid
B62166Medicare UPIN
VA006026982Medicaid