Healthcare Provider Details
I. General information
NPI: 1891171237
Provider Name (Legal Business Name): REBECCA LEANNE GREGOR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 08/08/2015
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
271 CAREW ST
SPRINGFIELD MA
01104-2377
US
IV. Provider business mailing address
63 NORTH ST
ENFIELD CT
06082-3915
US
V. Phone/Fax
- Phone: 413-748-9000
- Fax:
- Phone: 413-636-5347
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363AM0700X |
| Taxonomy | Medical Physician Assistant |
| License Number | PA5433 |
| License Number State | MA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: