Provider Demographics
NPI:1396795399
Name:STOUT, GREGORY M (DO)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:M
Last Name:STOUT
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1200 S CEDAR CREST BLVD.
Mailing Address - Street 2:3RD FLOOR ANDERSON WING
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105
Mailing Address - Country:US
Mailing Address - Phone:610-402-5369
Mailing Address - Fax:610-402-5959
Practice Address - Street 1:1200 S CEDAR CREST BLVD.
Practice Address - Street 2:3RD FLOOR ANDERSON WING
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18105
Practice Address - Country:US
Practice Address - Phone:610-402-5369
Practice Address - Fax:610-402-5959
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-02-09
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Provider Licenses
StateLicense IDTaxonomies
PAOS012250207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00165766OtherPALMETTO GBA MEDICARE
PA50044398OtherCAPITAL BLUE CROSS
PA1619023OtherHIGHMARK PA BLUE SHIELD
PA080302H9MMedicare PIN
PA1619023OtherHIGHMARK PA BLUE SHIELD
PA50044398OtherCAPITAL BLUE CROSS