Healthcare Provider Details

I. General information

NPI: 1538346564
Provider Name (Legal Business Name): ASSOCIATED FOOT CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 EAST AVE
LEWISTON ME
04240
US

IV. Provider business mailing address

95 EAST AVE
LEWISTON ME
04240-5623
US

V. Phone/Fax

Practice location:
  • Phone: 207-783-4714
  • Fax:
Mailing address:
  • Phone: 207-783-4714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPOD193
License Number StateME

VIII. Authorized Official

Name: DR. JOSEPH A GRECO
Title or Position: PRESIDENT/PODIATRIST
Credential: D.P.M.
Phone: 207-783-4714