Provider Demographics
NPI:1891712592
Name:WLODARSKI, GREGORY H (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:H
Last Name:WLODARSKI
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 1:289 OLMSTED BLVD STE 7
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9023
Mailing Address - Country:US
Mailing Address - Phone:910-295-2900
Mailing Address - Fax:910-295-2935
Practice Address - Street 1:2821 DAGGETT AVE STE 200
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1106
Practice Address - Country:US
Practice Address - Phone:541-274-8400
Practice Address - Fax:541-274-8405
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD192071207Q00000X
NC95-01458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500762160Medicaid
NC88721OtherBCBS
NC8988721Medicaid
NC8988721Medicaid