Provider Demographics
NPI:1164985040
Name:BIRES, GRETA LOCHIE SCHNEIDER (MD)
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:LOCHIE SCHNEIDER
Last Name:BIRES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRETA
Other - Middle Name:LOCHIE
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 E OLNEY AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2470
Mailing Address - Country:US
Mailing Address - Phone:215-456-1825
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:5201 OLD YORK RD STE 311
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2987
Practice Address - Country:US
Practice Address - Phone:215-457-7700
Practice Address - Fax:215-457-3601
Is Sole Proprietor?:No
Enumeration Date:2019-04-09
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD475023207RS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine