Provider Demographics
NPI:1134139793
Name:GRECO, PHILIP SCOT (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:SCOT
Last Name:GRECO
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 1:5249 DUKE ST.
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2978
Mailing Address - Country:US
Mailing Address - Phone:703-370-8060
Mailing Address - Fax:703-370-3996
Practice Address - Street 1:5249 DUKE ST.
Practice Address - Street 2:SUITE 307
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2978
Practice Address - Country:US
Practice Address - Phone:703-370-8060
Practice Address - Fax:703-370-3996
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-0295772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA088203OtherANTHEM BLUE CROSS
VA7175493Medicaid
VA088203OtherANTHEM BLUE CROSS
VAC62092Medicare UPIN