Basic Information
| Provider Information | |||||||||
| NPI: | 1255332623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEBRANK | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 SOUTH ST | ||||||||
| Address2: | SUITE G-20 | ||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156012775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248329190 | ||||||||
| FaxNumber: | 7248328705 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 SOUTH ST | ||||||||
| Address2: | SUITE G-20 | ||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156012775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248329190 | ||||||||
| FaxNumber: | 7248328705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207V00000X | MD029384E | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0010487600002 | 05 | PA | MEDICAID |