Provider Demographics
NPI:1114004512
Name:HARRINGTON, GREG G
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:G
Last Name:HARRINGTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-0435
Mailing Address - Country:US
Mailing Address - Phone:989-673-3141
Mailing Address - Fax:
Practice Address - Street 1:401 N HOOPER ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1476
Practice Address - Country:US
Practice Address - Phone:989-673-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N64900Medicare ID - Type Unspecified