Provider Demographics
NPI:1205823390
Name:FACEMYER, GREGORY J (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:FACEMYER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:330-325-3202
Mailing Address - Fax:833-606-1565
Practice Address - Street 1:4211 STATE ROUTE 44 STE 203
Practice Address - Street 2:
Practice Address - City:ROOTSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44272-9733
Practice Address - Country:US
Practice Address - Phone:330-325-3202
Practice Address - Fax:833-606-1565
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2024-08-19
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Provider Licenses
StateLicense IDTaxonomies
OH35.072943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2125542Medicaid
OH0879802Medicare PIN
G95790Medicare UPIN