Provider Demographics
NPI:1659463750
Name:GRECO, STEPHEN C (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
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:PO BOX 64474
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4474
Mailing Address - Country:US
Mailing Address - Phone:410-933-7400
Mailing Address - Fax:
Practice Address - Street 1:6420 ROCKLEDGE DR
Practice Address - Street 2:SUITE 1200
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7837
Practice Address - Country:US
Practice Address - Phone:301-896-2012
Practice Address - Fax:301-896-6331
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00521532085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21225933776OtherBEECH STREET
MD0655007-00Medicaid
DC0344309-00Medicaid
MD1807814OtherFIRST HEALTH
MD360073OtherUNITED HEALTHCARE
MD4751OtherELDER HEALTH
MD2700704OtherAETNA HMO
MD5763592OtherAETNA PPO/POS
MD501463OtherNCPPO
DCS357-0002OtherDC CAREFIRST BC/BS
MD4175696001OtherCIGNA
MD52184OtherAMERIGROUP/AMERICAID
MD2138231OtherMAMSI
MD613717-01OtherMD CAREFIRST BC/BS
MD360073OtherUNITED HEALTHCARE
MD4175696001OtherCIGNA