Basic Information
| Provider Information | |||||||||
| NPI: | 1013390756 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WRIGHT | ||||||||
| FirstName: | GREGORY | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 734 N FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172952323 | ||||||||
| FaxNumber: | 7172951349 | ||||||||
| Practice Location | |||||||||
| Address1: | 203 COMMERCE DR | ||||||||
| Address2: | SUITE G | ||||||||
| City: | QUARRYVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175669020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177861202 | ||||||||
| FaxNumber: | 7177867758 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2015 | ||||||||
| LastUpdateDate: | 07/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MA057616 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 423702F8R | 01 | PA | MEDICARE | OTHER |