Healthcare Provider Details

I. General information

NPI: 1730262148
Provider Name (Legal Business Name): FRANK GRECO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 GROVE ST
LEXINGTON MA
02420-1014
US

IV. Provider business mailing address

250 GROVE ST
LEXINGTON MA
02420-1014
US

V. Phone/Fax

Practice location:
  • Phone: 781-860-9897
  • Fax:
Mailing address:
  • Phone: 781-860-9897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number53751
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number53751
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: