MEDICARE: DONALD J GRECO MD INC

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1508040122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD J GRECO MD INC

Provider Business Mailing Address
First Line	:	16899 ALGONQUIN ST
Second Line	:	STE A
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-5607
Country	:	US
Telephone Number	:	714-840-2447
Fax Number	:	714-840-3278

Provider Business Practice Location Address
First Line	:	16899 ALGONQUIN ST
Second Line	:	STE A
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92649-5607
Country	:	US
Telephone Number	:	714-840-2447
Fax Number	:	714-840-3278

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. DONALD JAMES GRECO
Credential	:	MD
Telephone Number	:	714-840-2447

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	04/22/2008

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