Provider Demographics
NPI:1447277215
Name:DEW, GREGORY SCOTT (DC, PA-C)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:SCOTT
Last Name:DEW
Suffix:
Gender:M
Credentials:DC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 TRAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5007
Mailing Address - Country:US
Mailing Address - Phone:330-758-6440
Mailing Address - Fax:330-758-6990
Practice Address - Street 1:914 TRAILWOOD DR
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5007
Practice Address - Country:US
Practice Address - Phone:330-758-6440
Practice Address - Fax:330-758-6990
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2533111N00000X
OH2255363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000353868OtherANTHEM
OH2541968Medicaid
OHP00261050OtherRAIL ROAD MEDICARE
OH2541968Medicaid
OH4150271Medicare ID - Type Unspecified
OHU58742Medicare UPIN