Healthcare Provider Details

I. General information

NPI: 1740803550
Provider Name (Legal Business Name): NICHOLAS ALLEN GREGORY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 SENTRY PKWY E STE 200
BLUE BELL PA
19422-2332
US

IV. Provider business mailing address

9800 SHELBYVILLE RD STE 220
LOUISVILLE KY
40223-2992
US

V. Phone/Fax

Practice location:
  • Phone: 800-999-1249
  • Fax: 855-656-7325
Mailing address:
  • Phone: 800-999-1249
  • Fax: 855-656-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD496262
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: