Provider Demographics
NPI:1801996301
Name:GREGORY, THOMAS VINCENT (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:VINCENT
Last Name:GREGORY
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 1:201 ARBOR CT E
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-2152
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 BAY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2553
Practice Address - Country:US
Practice Address - Phone:609-927-3828
Practice Address - Fax:609-926-8067
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02700900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
904401OtherUNITED
NJ1816900Medicaid
NJ0075695000OtherAMERIHEALTH
NJ0075695000OtherAMERIHEALTH
NJ064351A0PMedicare ID - Type Unspecified