Provider Demographics
NPI:1295752822
Name:GREGORY, JAMES GORDON (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:GORDON
Last Name:GREGORY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142-3307
Mailing Address - Country:US
Mailing Address - Phone:724-946-8303
Mailing Address - Fax:
Practice Address - Street 1:3131 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1175
Practice Address - Country:US
Practice Address - Phone:724-652-3505
Practice Address - Fax:866-588-2705
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094854207P00000X
PAMD065489L207P00000X, 207Q00000X
OH35.093067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017006670002Medicaid
F92157Medicare UPIN
PA014381L5BMedicare PIN