Provider Demographics
NPI:1942297635
Name:CLEVELAND, GREGOR G (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGOR
Middle Name:G
Last Name:CLEVELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1303 AZALEA CT
Mailing Address - Street 2:STE C
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5765
Mailing Address - Country:US
Mailing Address - Phone:843-692-0570
Mailing Address - Fax:843-497-9566
Practice Address - Street 1:1303 AZALEA CT
Practice Address - Street 2:SUITE C
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5765
Practice Address - Country:US
Practice Address - Phone:843-692-0570
Practice Address - Fax:843-497-9566
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2016-09-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC159022085R0202X, 2085B0100X, 2085D0003X, 2085U0001X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0001X, 2085R0205X, 2085R0203X, 207U00000X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC60773OtherMEDCOST
NC05905OtherBCBS OF NC
SC154758900OtherFEDERAL BLACK LUNG
SC570525838OtherSTANDARD TAX ID
NC890603ROtherMEDICAID OF NC
SC300049800OtherRAILROAD MEDICARE
SC159027Medicaid
SC154758900OtherUS DEPT OF LABOR
NC890603ROtherMEDICAID OF NC
SCF300831371Medicare Oscar/Certification