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General NPI Number Information
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NPI Number | 1730173915
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Entity Type | Individual
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Provider Name | CARLA J. GREGORY PA
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Gender | Female
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Dates
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Enumeration Date | 09/02/2005
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Last Update Date | 02/10/2016
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Provider Practice Location Address
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Address Line | 725 NORTH PIKE STREET
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City | GRAFTON
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State | WV
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Zip | 26354-1270
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Country | US
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Telephone | 304-265-4909
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Fax | 304-266-4915
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Provider Business Mailing Address
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Address Line | PO BOX 35
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City | NEWBURG
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State | WV
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Zip | 26410-0035
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Country | US
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Telephone | 304-892-2828
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Fax | 304-892-2927
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 499
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License Number State | WV
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