Healthcare Provider Details

I. General information

NPI: 1972875763
Provider Name (Legal Business Name): GREGORY CHRISTOPHER TREHARNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ONE NORWEGIAN PLAZA
POTTSVILLE PA
17901-6029
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4903
US

V. Phone/Fax

Practice location:
  • Phone: 570-622-8500
  • Fax: 570-622-0261
Mailing address:
  • Phone: 570-271-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number336102126
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD462891
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: