Healthcare Provider Details

I. General information

NPI: 1154315398
Provider Name (Legal Business Name): GREGORY GERARD DEGNAN VI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3263 PROFFIT RD STE 202
CHARLOTTESVILLE VA
22911-5639
US

IV. Provider business mailing address

PO BOX 79777
BALTIMORE MD
21279-0777
US

V. Phone/Fax

Practice location:
  • Phone: 434-654-5575
  • Fax: 434-654-5574
Mailing address:
  • Phone: 434-654-7794
  • Fax: 434-654-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101041387
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number0101041387
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: