MEDICARE: DR. STEPHEN GREVIOUS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	031408	CT

General Provider Information

NPI Number	:	1093753972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN GREVIOUS M.D.

Provider Business Mailing Address
First Line	:	7 PARK ST
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06851-4811
Country	:	US
Telephone Number	:	203-840-7566
Fax Number	:	203-840-7569

Provider Business Practice Location Address
First Line	:	7 PARK ST
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06851-4811
Country	:	US
Telephone Number	:	203-840-7566
Fax Number	:	203-840-7569

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	10/28/2009

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Directions to “ DR. STEPHEN GREVIOUS M.D.” Practice Location

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