Provider Demographics
NPI:1861462293
Name:MAYER, GREGORY A (DPM)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:A
Last Name:MAYER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014C NEW GARDEN ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2522
Mailing Address - Country:US
Mailing Address - Phone:336-286-9640
Mailing Address - Fax:336-286-9652
Practice Address - Street 1:2014C NEW GARDEN ROAD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2522
Practice Address - Country:US
Practice Address - Phone:336-286-9640
Practice Address - Fax:336-286-9652
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC170213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908151Medicaid
NC2702271OtherUHC
NC480004627OtherRAILROAD MEDICARE
NC6582562002OtherCIGNA
NC08151OtherBCBS
NC243107Medicare PIN
NCT64065Medicare UPIN