Provider Demographics
NPI:1356225361
Name:KAMMERER, GREG THOMAS
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:THOMAS
Last Name:KAMMERER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8322 COUNTRY OAKS STA
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-2768
Mailing Address - Country:US
Mailing Address - Phone:513-544-0871
Mailing Address - Fax:
Practice Address - Street 1:8322 COUNTRY OAKS STA
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2768
Practice Address - Country:US
Practice Address - Phone:513-544-0871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver