Provider Demographics
NPI:1629028931
Name:BINUS, GREGORY KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:KEITH
Last Name:BINUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:32 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2503
Mailing Address - Country:US
Mailing Address - Phone:617-969-3322
Mailing Address - Fax:781-687-2428
Practice Address - Street 1:32 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-2503
Practice Address - Country:US
Practice Address - Phone:617-969-3322
Practice Address - Fax:781-687-2428
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA344422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABI C04704Medicare ID - Type UnspecifiedFOR MEDICARE BILLING