Provider Demographics
NPI:1508825092
Name:DEHMER, GREGORY J (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:DEHMER
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 1:2001 CRYSTAL SPRING AVE SW STE 203
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2465
Mailing Address - Country:US
Mailing Address - Phone:540-982-8204
Mailing Address - Fax:540-224-1059
Practice Address - Street 1:2001 CRYSTAL SPRING AVE SW STE 203
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2465
Practice Address - Country:US
Practice Address - Phone:540-982-8204
Practice Address - Fax:540-224-1059
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2022-07-05
Deactivation Date:2022-01-31
Deactivation Code:
Reactivation Date:2022-07-05
Provider Licenses
StateLicense IDTaxonomies
TXE7880207RI0011X
VA0101264003207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX060064210OtherRR/MEDICARE
TX1446437-01Medicaid
TX8B0912OtherBLUE SHIELD
TX1446437-02OtherCSHCN
TX060064210OtherRR/MEDICARE
TX8B0912OtherBLUE SHIELD