MEDICARE: DR. SCOTT CHARLES GREVEY 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	207ND0101X	MOHS-Micrographic Surgery Physician	35060409	OH
2	207ND0900X	Dermatopathology Physician	35060409	OH
3	207NP0225X	Pediatric Dermatology Physician	35060409	OH
4	207NS0135X	Procedural Dermatology Physician	35060409	OH
5	207N00000X	Dermatology Physician	35060409	OH

General Provider Information

NPI Number	:	1699713107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT CHARLES GREVEY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 645021
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45264
Country	:	US
Telephone Number	:	513-858-6900
Fax Number	:	513-858-6903

Provider Business Practice Location Address
First Line	:	1213 NILLES RD
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-2911
Country	:	US
Telephone Number	:	513-858-6900
Fax Number	:	513-858-6903

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	12/14/2020

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