Provider Demographics
NPI:1386615425
Name:OLIVER, GREGORY C (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:C
Last Name:OLIVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3900 PARK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3032
Mailing Address - Country:US
Mailing Address - Phone:732-494-6640
Mailing Address - Fax:732-549-8204
Practice Address - Street 1:3900 PARK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3032
Practice Address - Country:US
Practice Address - Phone:732-494-6640
Practice Address - Fax:732-549-8204
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04291500208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1956507Medicaid
NJOL558024Medicare ID - Type Unspecified
NJ1956507Medicaid