Provider Demographics
NPI:1760456370
Name:CETTON, GREGORY ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLEN
Last Name:CETTON
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:63 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-1501
Practice Address - Country:US
Practice Address - Phone:570-662-7766
Practice Address - Fax:570-662-0348
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227026207Q00000X
PAMD069307L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017133980005Medicaid
NY02081001Medicaid
PA080176503OtherRR MEDICARE PIN
PACC9269OtherRR MEDICARE GROUP
PAGU040009OtherMEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
PA0017133980005Medicaid