Provider Demographics
NPI:1932177896
Name:STILL, GREGORY L (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:STILL
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 1:32 ROUND HILL DR
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-3613
Mailing Address - Country:US
Mailing Address - Phone:540-639-0168
Mailing Address - Fax:
Practice Address - Street 1:4676 LEE HWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084-3871
Practice Address - Country:US
Practice Address - Phone:540-674-8805
Practice Address - Fax:540-674-8670
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035521173000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5611431Medicaid
VA5611431Medicaid
VABO9762Medicare UPIN