Provider Demographics
NPI:1396777975
Name:LADAS, GREGORY JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOHN
Last Name:LADAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12117 RED ADMIRAL WAY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-5939
Mailing Address - Country:US
Mailing Address - Phone:301-916-6160
Mailing Address - Fax:301-916-9522
Practice Address - Street 1:2101 MEDICAL PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4053
Practice Address - Country:US
Practice Address - Phone:301-681-6600
Practice Address - Fax:301-681-3799
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD15160207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001OtherBLUE CROSS/BLUE SHIELD
181923029OtherMEDICARE RAILROAD
228252OtherUNITED HEALTHCARE - MAMSI
228252OtherUNITED HEALTHCARE - MAMSI
0001OtherBLUE CROSS/BLUE SHIELD