Healthcare Provider Details

I. General information

NPI: 1558565044
Provider Name (Legal Business Name): GREGG GABRIEL MARTYAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 WALNUT ST STE 801
PHILADELPHIA PA
19107-5005
US

IV. Provider business mailing address

2925 PROFESSIONAL PL STE 201
COLORADO SPRINGS CO
80904-8133
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-1500
  • Fax:
Mailing address:
  • Phone: 719-260-4767
  • Fax: 719-260-4765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberMD425153
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: