Healthcare Provider Details

I. General information

NPI: 1700873510
Provider Name (Legal Business Name): GREGOR SIEBERT P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6311 RICHMOND HWY
ALEXANDRIA VA
22306-6410
US

IV. Provider business mailing address

5000 COX RD SUITE 100
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 703-647-6087
  • Fax: 703-647-6088
Mailing address:
  • Phone: 804-968-5700
  • Fax: 804-217-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110004442
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: