Provider Demographics
NPI:1619964194
Name:FORTIER, GREGORY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:FORTIER
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-741-8180
Mailing Address - Fax:717-741-8196
Practice Address - Street 1:25 MONUMENT RD
Practice Address - Street 2:SUITE 94
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5060
Practice Address - Country:US
Practice Address - Phone:717-741-8180
Practice Address - Fax:717-741-8196
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038076E2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1521067OtherGATEWAY WMG
PA4275150OtherAETNA
PA50074886OtherCAPITAL BLUE CROSS-WMG
MD919374OtherCAREFIRST MD BCBS
PA031981OtherJOHNS HOPKINS
PA001085414Medicaid
PA135874OtherHIGHMARK BLUE SHIELD
PA20069234OtherAMERIHEALTH MERCY-WMG
PA237305OtherUNISON-WMG
PA4275150OtherAETNA
PA135874FLTMedicare PIN
PA001085414Medicaid