Provider Demographics
NPI:1104879154
Name:MIEDEN, GREGORY D (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:MIEDEN
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 1:2103 BAY CT
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9323
Mailing Address - Country:US
Mailing Address - Phone:336-310-4712
Mailing Address - Fax:336-450-1028
Practice Address - Street 1:606 N ELM ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4336
Practice Address - Country:US
Practice Address - Phone:336-889-8877
Practice Address - Fax:336-889-7832
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC367762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7958800Medicaid
NC7958800Medicaid
NC2187598FMedicare PIN
2187598Medicare ID - Type Unspecified