Provider Demographics
NPI:1841350717
Name:MAHR, GREGORY C (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:C
Last Name:MAHR
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:KINGSWOOD HOSPITAL
Mailing Address - Street 2:10300 WEST EIGHT MILE ROAD
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220
Mailing Address - Country:US
Mailing Address - Phone:248-691-4865
Mailing Address - Fax:
Practice Address - Street 1:KINGSWOOD HOSPITAL
Practice Address - Street 2:10300 WEST EIGHT MILE ROAD
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220
Practice Address - Country:US
Practice Address - Phone:248-691-4865
Practice Address - Fax:248-691-4877
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010479892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI309201510Medicaid
700H262290OtherBLUE CROSS-BLUE CROSS
GM047989OtherCHAMPUS-CHAMPUS
GM047989OtherCOMMERCIAL-COMMERCIAL NUMBER
MI309201510Medicaid
0H26229056Medicare ID - Type Unspecified