Provider Demographics
NPI:1457352841
Name:ENGEL, GREGORY SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:ENGEL
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 1:300 STATE ST STE 107
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1428
Mailing Address - Country:US
Mailing Address - Phone:814-877-3900
Mailing Address - Fax:814-877-3950
Practice Address - Street 1:300 STATE ST STE 107
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1428
Practice Address - Country:US
Practice Address - Phone:814-877-3900
Practice Address - Fax:814-877-3950
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039912E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1039021OtherGATEWAY
PA671662OtherBLUE SHIELD
PA165897OtherUNISON
WV1068886OtherW. VIRGINIA WORKERS COMP
NY01255316OtherNY MEDICAL ASSISTANCE
PA0012469450001Medicaid
PA212532OtherUPMC
PAP00263338OtherRR MEDICARE
NY00025686702OtherUNIVERA
NY0025686702OtherUNIVERA
OH0827609OtherOH MEDICAL ASSISTANCE
NY00025686702OtherUNIVERA
PA3981781OtherAETNA
PA671662E7CMedicare PIN