Provider Demographics
NPI:1710983267
Name:ABBAS, GREGORY M (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:ABBAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2944 BRECKENRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1409
Mailing Address - Country:US
Mailing Address - Phone:502-893-0159
Mailing Address - Fax:502-213-3853
Practice Address - Street 1:3515 POPLAR LEVEL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1009
Practice Address - Country:US
Practice Address - Phone:502-459-3760
Practice Address - Fax:502-459-3717
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY319958174400000X
KY31995207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000223729OtherBCBS
KY61-0719349OtherTAX ID
KY64017916Medicaid
KY64017916Medicaid
IN265400AMedicare PIN
KY0124011Medicare PIN
KY1265308Medicare ID - Type Unspecified