Healthcare Provider Details

I. General information

NPI: 1588831655
Provider Name (Legal Business Name): GREGORY ALEXANDER SKOCHKO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4261A RIDGE AVE
PHILADELPHIA PA
19129-1748
US

IV. Provider business mailing address

4261A RIDGE AVE
PHILADELPHIA PA
19129-1748
US

V. Phone/Fax

Practice location:
  • Phone: 215-795-5055
  • Fax: 215-278-9619
Mailing address:
  • Phone: 215-795-5055
  • Fax: 215-278-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS018119
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: