Healthcare Provider Details

I. General information

NPI: 1164348793
Provider Name (Legal Business Name): GREGORY PHILIP PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OLD YORK RD
ABINGTON PA
19001-3720
US

IV. Provider business mailing address

1404 BERKSHIRE DR
BENSALEM PA
19020-4265
US

V. Phone/Fax

Practice location:
  • Phone: 215-481-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number32598591
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: