Provider Demographics
NPI:1821037896
Name:CREEL, GREGORY (PA)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:CREEL
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 1:1103 JULIANA ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-4316
Mailing Address - Country:US
Mailing Address - Phone:304-422-5680
Mailing Address - Fax:304-424-4766
Practice Address - Street 1:800 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5340
Practice Address - Country:US
Practice Address - Phone:304-424-2111
Practice Address - Fax:904-346-0113
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV644207P00000X
NC102162363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00248120OtherRAILROAD MEDICARE
WVP00248120OtherRAILROAD MEDICARE
WVCRPA16153Medicare ID - Type Unspecified