Provider Demographics
NPI:1104819861
Name:GEORGIADIS, GREGORY M (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:GEORGIADIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 HUGHES DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3845
Mailing Address - Country:US
Mailing Address - Phone:419-291-3858
Mailing Address - Fax:419-482-8701
Practice Address - Street 1:2121 HUGHES DR
Practice Address - Street 2:SUITE 310
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3845
Practice Address - Country:US
Practice Address - Phone:419-291-3858
Practice Address - Fax:419-482-8701
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058405207XX0801X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000502458OtherANTHEM
OH01739OtherPARAMOUNT
OH12-16741OtherUHC
OH4418637OtherAETNA
OHP00366740OtherRRM
OH0962909OtherBCMH
OH0962909Medicaid
OH4944110Medicaid
OH12-16741OtherUHC
OH01739OtherPARAMOUNT
OHP00366740OtherRRM
OHGE0757913Medicare ID - Type Unspecified