Provider Demographics
NPI:1194883538
Name:GRISSO, GREG ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:ALAN
Last Name:GRISSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:STE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2001
Practice Address - Street 1:327 ROCK CRUSHER ROAD
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203
Practice Address - Country:US
Practice Address - Phone:336-636-5546
Practice Address - Fax:336-636-5145
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2009-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC562234742174400000X
NC9900516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC31491OtherPARTNERS
NC891273OtherMAMSI HMO
NCP00454351OtherRR MEDICARE
NC891206WMedicaid
NC1206WOtherBLUE CROSS
NC0407877OtherUNITED HEALTH CARE
NC86827OtherMEDCOST
NC291273OtherMAMSI - PPO
NC4997222005OtherCIGNA
NC2271143EMedicare PIN
NC291273OtherMAMSI - PPO
NCG34187Medicare UPIN