Provider Demographics
NPI:1891805073
Name:OXENKRUG, GREGORY F (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:OXENKRUG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GREGORY
Other - Middle Name:F
Other - Last Name:OXENKRUG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:750 WASHINGTON ST
Mailing Address - Street 2:NEMC BOX #836
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1526
Mailing Address - Country:US
Mailing Address - Phone:617-636-5000
Mailing Address - Fax:617-277-5322
Practice Address - Street 1:750 WASHINGTON ST
Practice Address - Street 2:NEMC BOX #836
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-5000
Practice Address - Fax:617-277-5322
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA475042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F89481Medicare UPIN
MAA31381Medicare PIN