Healthcare Provider Details

I. General information

NPI: 1558369900
Provider Name (Legal Business Name): GREGG DAVID SCHUBACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 03/07/2023
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 W ARLINGTON BLVD STE 210
GREENVILLE NC
27834-5758
US

IV. Provider business mailing address

PO BOX 30750
GREENVILLE NC
27833-0750
US

V. Phone/Fax

Practice location:
  • Phone: 252-931-7638
  • Fax: 252-931-7694
Mailing address:
  • Phone: 252-931-7638
  • Fax: 252-931-7694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberMD059410L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD059410L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2022-01961
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: