Healthcare Provider Details

I. General information

NPI: 1679526339
Provider Name (Legal Business Name): RICHARD G GRECO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 AMARAL STREET
E PROVIDENCE RI
02915
US

IV. Provider business mailing address

50 AMARAL ST
RIVERSIDE RI
02915-2205
US

V. Phone/Fax

Practice location:
  • Phone: 401-434-8009
  • Fax: 401-435-3634
Mailing address:
  • Phone: 401-434-8009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04561MD
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: