Provider Demographics
NPI:1699791699
Name:GRIECO, ROBERT L (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:GRIECO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 CONXTITUTION BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010
Mailing Address - Country:US
Mailing Address - Phone:724-843-0737
Mailing Address - Fax:724-843-0833
Practice Address - Street 1:2620 CONSTITUTION BLVD
Practice Address - Street 2:UPPER LEVEL
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1278
Practice Address - Country:US
Practice Address - Phone:724-847-4755
Practice Address - Fax:724-847-4702
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034064E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0001025890002Medicaid
PA459400LCKMedicare PIN
PA0001025890002Medicaid