Provider Demographics
NPI:1750320347
Name:RUNSER, GREGORY L (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:RUNSER
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 1:6024 HOOVER RD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8133
Mailing Address - Country:US
Mailing Address - Phone:614-875-8949
Mailing Address - Fax:614-539-4610
Practice Address - Street 1:6024 HOOVER RD.
Practice Address - Street 2:SUITE A
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8133
Practice Address - Country:US
Practice Address - Phone:614-875-8949
Practice Address - Fax:614-539-4610
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-060436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0874871Medicaid
OHRU0684194Medicare ID - Type Unspecified
OH0874871Medicaid