Provider Demographics
NPI:1740364413
Name:GREGORY A AITCHISON MD PC
Entity type:Organization
Organization Name:GREGORY A AITCHISON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:AITCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-347-9042
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:94711-0189
Mailing Address - Country:US
Mailing Address - Phone:541-347-9042
Mailing Address - Fax:541-347-4720
Practice Address - Street 1:1295 OREGON AVE
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9102
Practice Address - Country:US
Practice Address - Phone:541-347-9042
Practice Address - Fax:541-347-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR277384Medicaid
OR00024340000OtherBLUE CROSS
OR000845495000OtherBLUE CROSS
C92073Medicare UPIN
OR00024340000OtherBLUE CROSS