Provider Demographics
NPI:1801098348
Name:GREGG, MARY A (CNM)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:GREGG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:777 WEST STATE STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1359
Mailing Address - Country:US
Mailing Address - Phone:614-274-1455
Mailing Address - Fax:614-274-1433
Practice Address - Street 1:1160 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1352
Practice Address - Country:US
Practice Address - Phone:614-274-1455
Practice Address - Fax:614-274-1433
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH05519176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2161388Medicaid