Provider Demographics
NPI:1396739033
Name:DOHMEIER, GREGORY MARK (DO)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:MARK
Last Name:DOHMEIER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 OLD EMMORTON RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015
Mailing Address - Country:US
Mailing Address - Phone:410-569-9040
Mailing Address - Fax:410-569-7419
Practice Address - Street 1:2227 OLD EMMORTON RD
Practice Address - Street 2:SUITE 220
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015
Practice Address - Country:US
Practice Address - Phone:410-569-9040
Practice Address - Fax:410-569-7419
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH40769207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD199LOtherMEDICARE GROUP
MD350321600Medicaid
E89913Medicare UPIN