Provider Demographics
NPI:1891958229
Name:GARTH, GREGORY ALLEN (MD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALLEN
Last Name:GARTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:895 STATE FARM ROAD SUITE #301
Mailing Address - Street 2:BOONE REGIONAL EAR NOSE & THROAT ASSOCIATES PLLC
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4917
Mailing Address - Country:US
Mailing Address - Phone:828-265-4045
Mailing Address - Fax:828-262-0960
Practice Address - Street 1:895 STATE FARM ROAD
Practice Address - Street 2:SUITE 301
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4917
Practice Address - Country:US
Practice Address - Phone:828-265-4045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300154207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89133C6Medicaid
NC2012120Medicare Oscar/Certification
NCP00087812Medicare PIN
NC89133C6Medicaid