| Organization Name: | GARY GREGASAVITCH, DPM, PC |
| NPI Number: | 1215047352 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GARY F GREGASAVITCH (PRESIDENT/OWNER) |
| Mailing Address: | 44055 Riverside Pkwy Suite 228 Lansdowne |
| State: | VA US |
| Postal Code: | 201765179 |
| Phone Number: | 7038583211 |
| Fax Number: | 7038583212 |
| NPI Enumeration Date: | 08/30/2006 |
| NPI Last Update Date: | 02/14/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP1100X |
| License Number: | 0103300881 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Podiatric |
| Taxonomy Definition: | |