MEDICARE: DR. TATIANA W GREGOR ED.D

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
1	103TC0700X	Clinical Psychologist	PS 1108	ME

General Provider Information

NPI Number	:	1295705671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TATIANA W GREGOR ED.D

Provider Business Mailing Address
First Line	:	47 GREEN ST
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04330-7401
Country	:	US
Telephone Number	:	207-621-9944
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 ARSENAL ST
Second Line	:	11 SHS
City	:	AUGUSTA
State	:	ME
Zip	:	04333-0001
Country	:	US
Telephone Number	:	207-624-3982
Fax Number	:	207-287-6123

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	07/08/2007

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