Provider Demographics
NPI:1982751277
Name:GREGORY G. MACHIKO, M.D., LLC
Entity Type:Organization
Organization Name:GREGORY G. MACHIKO, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:MACHIKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-942-6262
Mailing Address - Street 1:2001 WATERDAM PLAZA DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MCMURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-5416
Mailing Address - Country:US
Mailing Address - Phone:724-942-6262
Mailing Address - Fax:724-942-9880
Practice Address - Street 1:2001 WATERDAM PLAZA DR
Practice Address - Street 2:SUITE 205
Practice Address - City:MCMURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-5416
Practice Address - Country:US
Practice Address - Phone:724-942-6262
Practice Address - Fax:724-942-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036665E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE55816Medicare UPIN