MEDICARE: GREGORY BANCROFT D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	SC-001795-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073543559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY BANCROFT D.P.M.

Provider Business Mailing Address
First Line	:	4014 LANCASTER AVE
Second Line	:	A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-1712
Country	:	US
Telephone Number	:	215-222-2225
Fax Number	:	215-222-3070

Provider Business Practice Location Address
First Line	:	4014 LANCASTER AVE
Second Line	:	A
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-1712
Country	:	US
Telephone Number	:	215-222-2225
Fax Number	:	215-222-3070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/17/2015

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