Provider Demographics
NPI:1194721563
Name:DEGREGORY, THOMAS RICHARD (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RICHARD
Last Name:DEGREGORY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:506 ATHENA DR
Mailing Address - Street 2:
Mailing Address - City:DELMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15626-1005
Mailing Address - Country:US
Mailing Address - Phone:724-468-6869
Mailing Address - Fax:724-468-6207
Practice Address - Street 1:372 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-9769
Practice Address - Country:US
Practice Address - Phone:724-219-4489
Practice Address - Fax:724-832-1385
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003093L207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008385760004Medicaid
PAB36408Medicare UPIN
PADE101512Medicare ID - Type Unspecified