Provider Demographics
NPI:1598066698
Name:GREGORIO, MARK A (DNP, APRN, CNP, NP-C)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:GREGORIO
Suffix:
Gender:M
Credentials:DNP, APRN, CNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-4005
Mailing Address - Country:US
Mailing Address - Phone:860-823-0645
Mailing Address - Fax:203-469-9925
Practice Address - Street 1:42 CONCORD ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-4005
Practice Address - Country:US
Practice Address - Phone:860-823-0645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-06
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.004539363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4539OtherAPRN
CT071501OtherRN
MARN2338443OtherRN/APRN