Provider Demographics
NPI:1770657488
Name:ADKINS, GREGORY (PA)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:ADKINS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2722
Mailing Address - Country:US
Mailing Address - Phone:513-281-4400
Mailing Address - Fax:513-281-4545
Practice Address - Street 1:2950 ROBERTSON AVE STE 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1267
Practice Address - Country:US
Practice Address - Phone:513-281-4400
Practice Address - Fax:513-281-4545
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-00-1985363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQ00235Medicare UPIN
OHADPA21832Medicare ID - Type Unspecified