Provider Demographics
NPI:1215918362
Name:GRECO, BERNADETTE R (CRNP)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:R
Last Name:GRECO
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 GRAND CENTRAL AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7580 BUCKINGHAM BLVD STE 110
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-3208
Practice Address - Country:US
Practice Address - Phone:410-760-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR127817363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP66566Medicare UPIN
MDF496Medicare ID - Type UnspecifiedMEDICARE