Healthcare Provider Details

I. General information

NPI: 1639339146
Provider Name (Legal Business Name): THOMAS ROBERT GREGG MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 GENESEE STREET JORDAN HEALTH AT WOODWARD
ROCHESTER NY
14611
US

IV. Provider business mailing address

82 HOLLAND STREET ALJHC
ROCHESTER NY
14605
US

V. Phone/Fax

Practice location:
  • Phone: 585-436-3040
  • Fax: 585-328-3812
Mailing address:
  • Phone: 585-423-5800
  • Fax: 585-423-2890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number255452
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: