Provider Demographics
NPI:1942223573
Name:CLOSKEY, GREGORY MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MARK
Last Name:CLOSKEY
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 1:830 OLD LANCASTER RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3118
Mailing Address - Country:US
Mailing Address - Phone:610-525-8110
Mailing Address - Fax:
Practice Address - Street 1:830 OLD LANCASTER RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3118
Practice Address - Country:US
Practice Address - Phone:610-525-8110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038267L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098735OtherBLUE SHIELD
PA0012981000002OtherPROMISE ID #
PA0012986000002Medicaid
PA390002631OtherTRVP #
PA098735HARMedicare ID - Type Unspecified
PA0012981000002OtherPROMISE ID #