Basic Information
| Provider Information | |||||||||
| NPI: | 1861466559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREGOR | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | MARGARET | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235010936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574460374 | ||||||||
| FaxNumber: | 7576242272 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 FAIRFAX AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235071914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574467438 | ||||||||
| FaxNumber: | 7576242272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 06/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 2201001218 | VA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | NON | 01 | VA | USA MANAGE D CARE | OTHER | NON | 01 | VA | CORVEL CORCARE | OTHER | 2122625 | 01 | VA | UHC/MAMSI/MDIPA | OTHER | NON | 01 | NC | BC/BS NC | OTHER | NON | 01 | VA | VA PREMIER | OTHER | NON | 01 | VA | MID-ATLANTIC/VICARE | OTHER | PAR | 01 | VA | VHN/P HCS | OTHER | NON | 01 | VA | CIGNA | OTHER | NON | 01 | VA | AETNA PPO | OTHER | NON | 01 | NC | MULTI PLAN | OTHER | NON | 01 | VA | FIRST HEALTH | OTHER | 139025 | 01 | VA | ANTHEM BC/BS | OTHER | NON | 05 | NC | MEDICAID | 010073391 | 05 | VA | MEDICAID | NON | 01 | VA | AMERICAS HEALTH PLAN | OTHER | PAR | 01 | VA | SENTARA OHP/SHP | OTHER |