Provider Demographics
NPI:1215069067
Name:KATHLEEN M GRECO M.D. P.C.
Entity type:Organization
Organization Name:KATHLEEN M GRECO M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-729-6869
Mailing Address - Street 1:77 SWANTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2039
Mailing Address - Country:US
Mailing Address - Phone:781-729-6869
Mailing Address - Fax:617-332-4974
Practice Address - Street 1:77 SWANTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2039
Practice Address - Country:US
Practice Address - Phone:781-729-6869
Practice Address - Fax:617-332-4974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA057881174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA057881OtherTUFTS ID
MAJ09207Medicare ID - Type Unspecified
MA057881OtherTUFTS ID