Provider Demographics
NPI:1013152008
Name:CARPENTER, GREGORY LOUIS (PA-C)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LOUIS
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:ATTN: DRMC BUSINESS OFFICE
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-3750
Mailing Address - Fax:814-375-9624
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-375-3750
Practice Address - Fax:814-375-9624
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000708363A00000X
PAMA053768363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA145337Medicare PIN