Individual
GREGORY EDWARD SUPPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4206
(215) 662-7355
(215) 349-8444
Mailing address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4206
(215) 662-7355
(215) 349-8444
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
MD436470
PA
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
MD436470
PA
Other
Enumeration date
02/26/2007
Last updated
05/22/2012
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