Gregory P. Derderian D.O., P.C.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

5101007182 Issued in MI

Legal business name

GREGORY P. DERDERIAN D.O., P.C.

Practice address

6770 Dixie Hwy
106A
Clarkston, MI 48346-2087

Phone

(248) 922-9371

Fax

(586) 493-3828

NPI assigned

Sep 25, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gregory P Derderian, M.D.

Title

Presideent

Phone

(586) 493-3175

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922108240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6770 DIXIE HWY",
            "address_2": "106A",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483462087",
            "telephone_number": "248-922-9371",
            "fax_number": "586-493-3828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6770 DIXIE HWY",
            "address_2": "106A",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483462087",
            "telephone_number": "248-922-9371",
            "fax_number": "586-493-3828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGORY P. DERDERIAN D.O., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DERDERIAN",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDEENT",
        "authorized_official_telephone_number": "586-493-3175",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "MI",
            "license": "5101007182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4406461",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Vascular Surgery Physician in Clarkston, MI
• Providers in Clarkston, MI by specialty
• Vascular Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.