Provider Demographics
NPI:1598728206
Name:GREATOREX, PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:GREATOREX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:887 CONGRESS ST
Practice Address - Street 2:SUITE 400
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3100
Practice Address - Country:US
Practice Address - Phone:207-774-6368
Practice Address - Fax:207-774-9338
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD15631208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME027844OtherANTHEM
ME306290099Medicaid
ME0753672001OtherCIGNA
ME099317OtherANTHEM
MEP00460355OtherRR MEDICARE
ME020052789OtherRR MEDICARE
MEH41582OtherHARVARD PILGRIM
ME1537576OtherAETNA
ME2619338OtherAETNA
ME015631Medicare PIN
ME306290099Medicaid
ME027844OtherANTHEM
ME0753672001OtherCIGNA
ME020052789OtherRR MEDICARE