Provider Demographics
NPI:1912501933
Name:FIELDS, GREGORY DEAN
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:DEAN
Last Name:FIELDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 BARDWELL WEST RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45176-9648
Mailing Address - Country:US
Mailing Address - Phone:513-724-2251
Mailing Address - Fax:
Practice Address - Street 1:1643 BARDWELL WEST RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:OH
Practice Address - Zip Code:45176-9648
Practice Address - Country:US
Practice Address - Phone:513-967-3694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0362562253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0362562Medicaid
OH1305185OtherDSP