Provider Demographics
NPI:1689656175
Name:GREGORY, MICHAEL R (DO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:GREGORY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 HOSPITAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452
Mailing Address - Country:US
Mailing Address - Phone:304-269-8000
Mailing Address - Fax:304-269-8090
Practice Address - Street 1:533 HACKERS CREEK ROAD
Practice Address - Street 2:
Practice Address - City:JANE LEW
Practice Address - State:WV
Practice Address - Zip Code:26378-8394
Practice Address - Country:US
Practice Address - Phone:304-884-8941
Practice Address - Fax:304-884-8943
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1554207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVG39993Medicare UPIN
WVGR7335501Medicare ID - Type UnspecifiedCMS
WVGR7335501Medicare PIN