Healthcare Provider Details

I. General information

NPI: 1124062963
Provider Name (Legal Business Name): NOEL STEPHEN GRESSIEUX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VILLAGE SQ
WESTMINSTER MD
21157-6145
US

IV. Provider business mailing address

PO BOX 900
WESTMINSTER MD
21158-0900
US

V. Phone/Fax

Practice location:
  • Phone: 410-871-8081
  • Fax:
Mailing address:
  • Phone: 410-871-6502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD0016998
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: