Provider Demographics
NPI:1942939624
Name:STANCIL, GREGORY T
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:T
Last Name:STANCIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 24TH PL SE APT 202
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-4590
Mailing Address - Country:US
Mailing Address - Phone:410-202-7128
Mailing Address - Fax:
Practice Address - Street 1:900 VARNEY ST SE # T10
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4310
Practice Address - Country:US
Practice Address - Phone:410-202-7128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0070331999Medicaid