Provider Demographics
NPI:1659457554
Name:MARLER, GREGORY S (NP)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:MARLER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-768-9535
Mailing Address - Fax:336-768-4155
Practice Address - Street 1:4622 COUNTRY CLUB RD STE 180
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3770
Practice Address - Country:US
Practice Address - Phone:336-768-9535
Practice Address - Fax:336-768-4155
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-01450363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC194977OtherMEDCOST
NC7004523Medicaid
NC194977OtherMEDCOST