Healthcare Provider Details

I. General information

NPI: 1518202969
Provider Name (Legal Business Name): RONALD PAUL GREGOIRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 CABBAGE INLET LN
WILMINGTON NC
28409-3004
US

IV. Provider business mailing address

207 CABBAGE INLET LN
WILMINGTON NC
28409-3004
US

V. Phone/Fax

Practice location:
  • Phone: 910-200-2419
  • Fax: 910-395-5156
Mailing address:
  • Phone: 910-200-2419
  • Fax: 910-395-5156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number60741
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: