Provider Demographics
NPI:1831105972
Name:MCANINCH, GREGG WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:WAYNE
Last Name:MCANINCH
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:PO BOX 2087
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-2087
Mailing Address - Country:US
Mailing Address - Phone:775-888-1180
Mailing Address - Fax:775-852-6902
Practice Address - Street 1:2874 N CARSON ST
Practice Address - Street 2:SUITE 215
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-0251
Practice Address - Country:US
Practice Address - Phone:775-888-1180
Practice Address - Fax:775-852-6902
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG647562085R0202X
NV72022085R0202X
WAMD000244072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVEP617ZMedicare PIN
NVEP617ZOtherMEDICARE PTAN NV TCR
NV1831105972Medicaid
1831105972OtherNPI
NVE33845Medicare UPIN