Provider Demographics
NPI:1598892077
Name:PELTON, GREGORY H (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:H
Last Name:PELTON
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 1:7119 CHARLES SPRING WAY
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-3735
Mailing Address - Country:US
Mailing Address - Phone:212-543-5957
Mailing Address - Fax:212-543-5088
Practice Address - Street 1:617 W END AVE
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1607
Practice Address - Country:US
Practice Address - Phone:212-579-0339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2073652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2531511OtherOXFORD PROVIDER
NY070BS1Medicare ID - Type Unspecified