Provider Demographics
NPI:1891750899
Name:TUKE, GREGORY CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:CHARLES
Last Name:TUKE
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 448
Mailing Address - Street 2:
Mailing Address - City:EAST PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17520-0448
Mailing Address - Country:US
Mailing Address - Phone:610-926-5707
Mailing Address - Fax:610-926-8352
Practice Address - Street 1:5 S CENTRE AVE
Practice Address - Street 2:A3
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8653
Practice Address - Country:US
Practice Address - Phone:610-926-5707
Practice Address - Fax:610-926-8352
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028848E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009771300008Medicaid
PA111217OtherHIGHMARK BLUE SHIELD
PA100278AOtherAMERIHEALTH MERCY
PA111217OtherHIGHMARK BLUE SHIELD
PA0009771300008Medicaid
PA01568601OtherCAPITAL BLUE CROSS
PA0038OtherAETNA
PA080025912OtherPALMETTO RR MEDICARE
PA01568601OtherCAPITAL BLUE CROSS
PA111217FSKMedicare ID - Type Unspecified