Provider Demographics
NPI:1467646125
Name:EDWARD A GRECO JR MD
Entity Type:Organization
Organization Name:EDWARD A GRECO JR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:207-774-6351
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:CAPE COTTAGE
Mailing Address - State:ME
Mailing Address - Zip Code:04107
Mailing Address - Country:US
Mailing Address - Phone:207-774-6351
Mailing Address - Fax:
Practice Address - Street 1:693 CONGRESS STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-774-6351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5223207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
135506Medicare PIN
MEC66713Medicare UPIN