Basic Information
| Provider Information | |||||||||
| NPI: | 1700025004 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREGORIO | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | GUY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1236 | ||||||||
| Address2: | |||||||||
| City: | BUTLER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160031236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129378887 | ||||||||
| FaxNumber: | 4129379221 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 S JACKSON AVE | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152023428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124151138 | ||||||||
| FaxNumber: | 4123010113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2009 | ||||||||
| LastUpdateDate: | 11/11/2014 | ||||||||
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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 | 207Q00000X | MD435287 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 102305749 | 05 | PA | MEDICAID |