Provider Demographics
NPI:1356679138
Name:TAMPUS, GREG VICTOR IGOT (MD)
Entity type:Individual
Prefix:
First Name:GREG VICTOR
Middle Name:IGOT
Last Name:TAMPUS
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 1:1300 YORK RD STE 190D
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6016
Mailing Address - Country:US
Mailing Address - Phone:443-288-5206
Mailing Address - Fax:443-288-5205
Practice Address - Street 1:1300 YORK RD STE 190D
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-6016
Practice Address - Country:US
Practice Address - Phone:443-288-5206
Practice Address - Fax:443-288-5205
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0076580207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD421974100Medicaid
MD327902Medicare PIN
VAC08690Medicare PIN