MEDICARE: DR. GREGORY MASLAK M.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	207R00000X	Internal Medicine Physician	064131	CT
2	208M00000X	Hospitalist Physician	064131	CT
3	207R00000X	Internal Medicine Physician	MT211838	PA

General Provider Information

NPI Number	:	1720439235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY MASLAK M.D.

Provider Business Mailing Address
First Line	:	245 N 15TH ST.
Second Line	:	DREXEL UNIVERSITY COLLEGE OF MEDICINE 6TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3129
Country	:	US
Telephone Number	:	215-762-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 N 15TH ST,
Second Line	:	DREXEL UNIVERSITY COLLEGE OF MEDICINE 6TH FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3129
Country	:	US
Telephone Number	:	215-762-7000
Fax Number	:

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

Provider Enumeration Date	:	06/27/2016
Last Update Date	:	03/08/2021

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