Provider Demographics
NPI:1255654539
Name:GRECZEK, NATHAN ANDREW (DO)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ANDREW
Last Name:GRECZEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2009
Mailing Address - Country:US
Mailing Address - Phone:570-383-0236
Mailing Address - Fax:570-383-3681
Practice Address - Street 1:1400 MAIN ST
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2009
Practice Address - Country:US
Practice Address - Phone:570-383-0236
Practice Address - Fax:570-383-3681
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016556207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028291490003Medicaid
PA1028291490004Medicaid
PA1028291490004Medicaid