Provider Demographics
NPI:1588744320
Name:GRECO, PETER C (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:GRECO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:133 SCOVILL STREET
Mailing Address - Street 2:SUITE 214
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1127
Mailing Address - Country:US
Mailing Address - Phone:203-753-6004
Mailing Address - Fax:203-755-3512
Practice Address - Street 1:133 SCOVILL STREET
Practice Address - Street 2:SUITE 214
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1127
Practice Address - Country:US
Practice Address - Phone:203-753-6004
Practice Address - Fax:203-755-3512
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2019-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT219712084N0400X
CT021971207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001219716Medicaid