Provider Demographics
NPI:1952362816
Name:HOANG, GREGORY B (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:B
Last Name:HOANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 534595
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-4595
Mailing Address - Country:US
Mailing Address - Phone:231-725-8300
Mailing Address - Fax:321-725-1555
Practice Address - Street 1:20 SAN FILIPPO DR SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-2200
Practice Address - Country:US
Practice Address - Phone:321-725-8300
Practice Address - Fax:321-725-1555
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2019-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME73490207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
830007452OtherRAIL ROAD MEDICARE
FL261560600Medicaid
FL261560600Medicaid
FL51001WMedicare PIN