Healthcare Provider Details

I. General information

NPI: 1356069850
Provider Name (Legal Business Name): GRECEANNII HEALTHCARE P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 MINSTREL WAY STE 120
COLUMBIA MD
21045-5329
US

IV. Provider business mailing address

7130 MINSTREL WAY STE 120
COLUMBIA MD
21045-5329
US

V. Phone/Fax

Practice location:
  • Phone: 443-241-7622
  • Fax:
Mailing address:
  • Phone: 314-922-4937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MAX GRECEANNII
Title or Position: CEO
Credential:
Phone: 314-922-4937