Provider Demographics
NPI:1982832960
Name:O'SHANICK, GREGORY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOHN
Last Name:O'SHANICK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7401 BEAUFONT SPRINGS DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5504
Mailing Address - Country:US
Mailing Address - Phone:804-272-0114
Mailing Address - Fax:804-272-1125
Practice Address - Street 1:7401 BEAUFONT SPRINGS DR
Practice Address - Street 2:SUITE 205
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-5504
Practice Address - Country:US
Practice Address - Phone:804-272-0114
Practice Address - Fax:804-272-1125
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2017-03-27
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Provider Licenses
StateLicense IDTaxonomies
VA01010369562084B0040X, 2084P0800X, 2084P0301X, 2084P0301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0301XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBrain Injury Medicine
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB25301Medicare UPIN