Provider Demographics
NPI:1730336009
Name:GRESENS, JOSEPH COLIN (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:COLIN
Last Name:GRESENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:844 KEMPSVILLE RD STE 212
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3927
Mailing Address - Country:US
Mailing Address - Phone:757-261-5977
Mailing Address - Fax:757-275-9913
Practice Address - Street 1:844 KEMPSVILLE RD STE 212
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3927
Practice Address - Country:US
Practice Address - Phone:757-261-5977
Practice Address - Fax:757-275-9913
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246116207R00000X, 207RP1001X, 207RC0200X
LAMD-207621207R00000X
NC2019-02099207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
72-6087770OtherTAX ID NUMBER