Healthcare Provider Details

I. General information

NPI: 1801992375
Provider Name (Legal Business Name): JOSEPH A GRECO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 02/11/2009
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
US

V. Phone/Fax

Practice location:
  • Phone: 207-783-4714
  • Fax: 207-783-6588
Mailing address:
  • Phone: 207-783-4714
  • Fax: 207-783-6588

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:
Title or Position:
Credential:
Phone: