Healthcare Provider Details

I. General information

NPI: 1093753972
Provider Name (Legal Business Name): STEPHEN GREVIOUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 10/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 PARK ST
NORWALK CT
06851-4811
US

IV. Provider business mailing address

7 PARK ST
NORWALK CT
06851-4811
US

V. Phone/Fax

Practice location:
  • Phone: 203-840-7566
  • Fax: 203-840-7569
Mailing address:
  • Phone: 203-840-7566
  • Fax: 203-840-7569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number031408
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: