Provider Demographics
NPI:1053399113
Name:OLENIC, GREGORY W (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:W
Last Name:OLENIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 COLLIERS WAY
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5014
Mailing Address - Country:US
Mailing Address - Phone:304-797-6595
Mailing Address - Fax:304-797-6052
Practice Address - Street 1:601 COLLIERS WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5014
Practice Address - Country:US
Practice Address - Phone:304-797-6595
Practice Address - Fax:304-797-6052
Is Sole Proprietor?:No
Enumeration Date:2006-01-08
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424234207L00000X
WV23967207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810017283Medicaid
WVP00826312OtherMEDICARE RR
OH2774814Medicaid
PA1010177580001Medicaid
WV4286341Medicare PIN
OH2774814Medicaid
WV4286342Medicare PIN
PA087565Medicare ID - Type Unspecified
PAI107432Medicare UPIN