Provider Demographics
NPI:1285170001
Name:EASTER, GREGORY
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:EASTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 MARYLAND AVE NE APT 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-3121
Mailing Address - Country:US
Mailing Address - Phone:202-213-2028
Mailing Address - Fax:
Practice Address - Street 1:2007 MARYLAND AVE NE APT 101
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3121
Practice Address - Country:US
Practice Address - Phone:202-213-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAB5C6A96390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program