Provider Demographics
NPI:1801992375
Name:GRECO, JOSEPH A (DPM)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:GRECO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240
Mailing Address - Country:US
Mailing Address - Phone:207-783-4714
Mailing Address - Fax:207-783-6588
Practice Address - Street 1:95 EAST AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-783-4714
Practice Address - Fax:207-783-6588
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD193213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002527OtherANTHEM BC/BS
ME480025851OtherRAILROAD MEDICARE
ME118360000Medicaid
ME1538346564OtherMEDICARE GROUP NPI
ME1538346564OtherMEDICARE GROUP NPI
T31370Medicare UPIN
ME0861930001Medicare NSC
MEMM2256Medicare PIN