Provider Demographics
NPI:1720135270
Name:TORAIN, GREGORY DEMOND (MED)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DEMOND
Last Name:TORAIN
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8379 PINEY ORCHARD PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1508
Mailing Address - Country:US
Mailing Address - Phone:410-382-3787
Mailing Address - Fax:
Practice Address - Street 1:8379 PINEY ORCHARD PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1508
Practice Address - Country:US
Practice Address - Phone:410-382-3787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1572101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health