MEDICARE: GREGORY BINGHAM A-GNP

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	363L00000X	Nurse Practitioner	AG06220004	MA

General Provider Information

NPI Number	:	1962134775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY BINGHAM A-GNP

Provider Business Mailing Address
First Line	:	1601 LEWIS O GRAY DR
Second Line	:
City	:	SAUGUS
State	:	MA
Zip	:	01906-4416
Country	:	US
Telephone Number	:	339-224-0512
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 LEWIS O GRAY DR
Second Line	:
City	:	SAUGUS
State	:	MA
Zip	:	01906-4416
Country	:	US
Telephone Number	:	339-224-0512
Fax Number	:

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

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	06/29/2022

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