Provider Demographics
NPI:1649488032
Name:D'ERAMO, GREGORY VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:VINCENT
Last Name:D'ERAMO
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:799 FARSON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1044
Practice Address - Country:US
Practice Address - Phone:740-423-3082
Practice Address - Fax:740-423-3083
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV234552081P2900X
OH35.0985692081P2900X
PAMD431639208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810014165Medicaid
OHP01487293OtherRAILROAD MEDICARE - MHCPI
WVD 4257271Medicare PIN
OHP01487293OtherRAILROAD MEDICARE - MHCPI
WV3810014165Medicaid