Provider Demographics
NPI:1255590808
Name:GREGORY ALAN. BARTLOW, M.D., INC.
Entity type:Organization
Organization Name:GREGORY ALAN. BARTLOW, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BARTLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD, INC
Authorized Official - Phone:949-718-1222
Mailing Address - Street 1:1845 ANAHEIM AVE
Mailing Address - Street 2:4C
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5028
Mailing Address - Country:US
Mailing Address - Phone:949-874-6540
Mailing Address - Fax:
Practice Address - Street 1:1441 AVOCADO AVE
Practice Address - Street 2:806
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7721
Practice Address - Country:US
Practice Address - Phone:949-718-1222
Practice Address - Fax:949-718-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-07
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24898207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA24184Medicare UPIN