1770667388 NPI number — DR. JEFFREY M GRECO MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770667388 NPI number — DR. JEFFREY M GRECO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRECO
Provider First Name:
JEFFREY
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GURBA
Provider Other First Name:
TRACI
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1770667388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 S HICKORY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT CARMEL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-339-2160
Provider Business Mailing Address Fax Number:
570-339-4193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 S HICKORY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT CARMEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-339-2160
Provider Business Practice Location Address Fax Number:
570-339-4193
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD032392E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0010545990001 . This is a "MED ASSIST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02325000 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MA01054599 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1464870 . This is a "KEYSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: DA2400 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1464870 . This is a "BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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