Provider Demographics
NPI:1629178850
Name:GREENSBORO GYNECOLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:GREENSBORO GYNECOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTSEGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-544-4599
Mailing Address - Street 1:719 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7014
Mailing Address - Country:US
Mailing Address - Phone:336-544-4599
Mailing Address - Fax:336-544-4580
Practice Address - Street 1:719 GREEN VALLEY RD
Practice Address - Street 2:SUITE 305
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7014
Practice Address - Country:US
Practice Address - Phone:336-544-4599
Practice Address - Fax:336-544-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC230193Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER