Provider Demographics
NPI:1639217458
Name:MORGANROTH, GREG S (MD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:S
Last Name:MORGANROTH
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 1:525 SOUTH DRIVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040
Mailing Address - Country:US
Mailing Address - Phone:650-969-5600
Mailing Address - Fax:650-969-0360
Practice Address - Street 1:525 SOUTH DRIVE
Practice Address - Street 2:SUITE 115
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040
Practice Address - Country:US
Practice Address - Phone:650-969-5600
Practice Address - Fax:650-969-0360
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81771207ND0101X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G817710Medicare PIN
CAF80568Medicare UPIN