Healthcare Provider Details

I. General information

NPI: 1821037896
Provider Name (Legal Business Name): GREGORY CREEL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GARFIELD AVE
PARKERSBURG WV
26101-5340
US

IV. Provider business mailing address

1103 JULIANA ST
PARKERSBURG WV
26101-4316
US

V. Phone/Fax

Practice location:
  • Phone: 304-424-2111
  • Fax: 904-346-0113
Mailing address:
  • Phone: 304-422-5680
  • Fax: 304-424-4766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number644
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number102162
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: