Provider Demographics
NPI:1245271493
Name:GARY M GREGER DPM INC
Entity type:Organization
Organization Name:GARY M GREGER DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-479-5428
Mailing Address - Street 1:6227 FRANK AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-8439
Mailing Address - Country:US
Mailing Address - Phone:330-244-9688
Mailing Address - Fax:330-244-1966
Practice Address - Street 1:6227 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-8439
Practice Address - Country:US
Practice Address - Phone:330-244-9688
Practice Address - Fax:330-244-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH36002696213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0862160Medicaid