Provider Demographics
NPI:1083718464
Name:GRECO, THOMAS PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PETER
Last Name:GRECO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:133 SCOVILL ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1127
Mailing Address - Country:US
Mailing Address - Phone:203-709-3667
Mailing Address - Fax:203-709-3663
Practice Address - Street 1:133 SCOVILL ST
Practice Address - Street 2:SUITE 306
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1127
Practice Address - Country:US
Practice Address - Phone:203-709-3667
Practice Address - Fax:203-709-3663
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2015-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT016133207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001161330Medicaid
CT490000049Medicare PIN
CT001161330Medicaid