Provider Demographics
NPI:1639251820
Name:ENDERS, GREGORY H (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:H
Last Name:ENDERS
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 1:743 JEFFERSON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1639
Mailing Address - Country:US
Mailing Address - Phone:570-558-0182
Mailing Address - Fax:570-558-0183
Practice Address - Street 1:743 JEFFERSON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1639
Practice Address - Country:US
Practice Address - Phone:570-558-0182
Practice Address - Fax:570-558-0183
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 058911174400000X
PAMD058911L207RH0003X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016109440002Medicaid
PA0016109440002Medicaid