Provider Demographics
NPI:1053604728
Name:GREY, ELEONORA I (DO)
Entity type:Individual
Prefix:
First Name:ELEONORA
Middle Name:I
Last Name:GREY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 RED OAKS SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-1364
Mailing Address - Country:US
Mailing Address - Phone:304-689-4488
Mailing Address - Fax:866-920-6674
Practice Address - Street 1:320 RED OAKS SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-1364
Practice Address - Country:US
Practice Address - Phone:304-689-4488
Practice Address - Fax:304-927-8198
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2651208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty