Provider Demographics
NPI:1588831655
Name:SKOCHKO, GREGORY ALEXANDER (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALEXANDER
Last Name:SKOCHKO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5458 RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3732
Mailing Address - Country:US
Mailing Address - Phone:215-487-1887
Mailing Address - Fax:215-487-1818
Practice Address - Street 1:5458 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3732
Practice Address - Country:US
Practice Address - Phone:215-487-1887
Practice Address - Fax:215-487-1818
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031139500001Medicaid