Provider Demographics
NPI:1780631531
Name:GREY, THADDEUS ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:THADDEUS
Middle Name:ANDREW
Last Name:GREY
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 1:848 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-1121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:519 BROOKLINE BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15226-2001
Practice Address - Country:US
Practice Address - Phone:412-341-2793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA039737L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0432OtherUPMC PROVIDER ID
PA0496370OtherUS HEALTHCARE
PA42047OtherAETNA
PA64214OtherBLUE SHIELD
PA406006OtherHIGHMARK
PAB34701Medicare UPIN