Healthcare Provider Details

I. General information

NPI: 1780726158
Provider Name (Legal Business Name): PAUL M. GREIF, M.D., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 WAWECUS ST SUITE 102
NORWICH CT
06360-2160
US

IV. Provider business mailing address

79 WAWECUS ST SUITE 102
NORWICH CT
06360-2160
US

V. Phone/Fax

Practice location:
  • Phone: 860-204-9735
  • Fax: 860-204-9793
Mailing address:
  • Phone: 860-204-9735
  • Fax: 860-204-9793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number034821
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number046328
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number034821
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number046328
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number034821
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number046328
License Number StateCT

VIII. Authorized Official

Name: PAUL M GREIF
Title or Position: OWNER
Credential: M.D.
Phone: 860-204-9735