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NPI Code Detail

MEDICARE: DR. GREGORY S WILLIS DO

MEDICARE: DR. GREGORY S WILLIS DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207VX0201XGynecologic Oncology PhysicianOS009400LPA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184605677
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY S WILLIS DO
Provider Business Mailing Address
First Line : 409 S 2ND ST STE 2F
Second Line :
City : HARRISBURG
State : PA
Zip : 17104-1612
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1703 INNOVATION DR STE 2001
Second Line :
City : YORK
State : PA
Zip : 17408-8815
Country : US
Telephone Number : 717-801-0739
Fax Number : 717-801-0645
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2005
Last Update Date : 01/23/2021

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