Provider Demographics
NPI:1831164102
Name:GREGG, WILLIAM (CRNP)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:GREGG
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 244
Mailing Address - Street 2:BUTTERMILK FALLS ROAD
Mailing Address - City:SHAWNEE-ON-DELAWARE
Mailing Address - State:PA
Mailing Address - Zip Code:18356-0244
Mailing Address - Country:US
Mailing Address - Phone:570-421-3900
Mailing Address - Fax:570-424-1549
Practice Address - Street 1:106 SHAWNEE SQUARE DR. STE 101
Practice Address - Street 2:
Practice Address - City:SHAWNEE-ON-DELAWARE
Practice Address - State:PA
Practice Address - Zip Code:18356
Practice Address - Country:US
Practice Address - Phone:570-421-3900
Practice Address - Fax:570-424-1549
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005354B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007575050001Medicaid
PA744447OtherBLUE SHIELD
PA1007575050001Medicaid
PA744447OtherBLUE SHIELD