Healthcare Provider Details

I. General information

NPI: 1306209622
Provider Name (Legal Business Name): DOMINIK S. GREDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 HOSPITAL RD STE G70
CHILLICOTHEE OH
45601-9031
US

IV. Provider business mailing address

272 HOSPITAL RD STE G70
CHILLICOTHEE OH
45601-9031
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4393
  • Fax:
Mailing address:
  • Phone: 740-779-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35.142982
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: