Healthcare Provider Details

I. General information

NPI: 1659356384
Provider Name (Legal Business Name): BRIAN L. GRETTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARKLAND DR
DERRY NH
03038-2746
US

IV. Provider business mailing address

63 MERGANSER COVE RD
ORRS ISLAND ME
04066-2408
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-3321
  • Fax:
Mailing address:
  • Phone: 603-432-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number205530
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD13084
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number62698
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: