Provider Demographics
NPI:1952312183
Name:GREGORY, JOHN B (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:GREGORY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ALICE PECK DAY DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2900
Mailing Address - Country:US
Mailing Address - Phone:603-443-9572
Mailing Address - Fax:603-443-9521
Practice Address - Street 1:127 MASCOMA ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-2661
Practice Address - Country:US
Practice Address - Phone:603-443-9572
Practice Address - Fax:603-443-9521
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0305213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011596Medicaid
U71898OtherHARVARD PILGRIM
NH03Y007385NH02OtherANTHEM BCBS
VT00068170OtherBLUE CROSS BLUE SHIELD
NH30363594Medicaid
VT00068170OtherBLUE CROSS BLUE SHIELD
P00246999Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VT1011596Medicaid