Healthcare Provider Details

I. General information

NPI: 1710960547
Provider Name (Legal Business Name): GREGORY ALAN DEYE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 402 BOX 2422
APO AE
09180
US

IV. Provider business mailing address

9704 HILLRIDGE DR
KENSINGTON MD
20895-3225
US

V. Phone/Fax

Practice location:
  • Phone: 011496371868156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101240928
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: