Provider Demographics
NPI:1679526339
Name:GRECO, RICHARD G (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:G
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 1:50 AMARAL ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-2205
Mailing Address - Country:US
Mailing Address - Phone:401-434-8009
Mailing Address - Fax:
Practice Address - Street 1:50 AMARAL STREET
Practice Address - Street 2:
Practice Address - City:E PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915
Practice Address - Country:US
Practice Address - Phone:401-434-8009
Practice Address - Fax:401-435-3634
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI04561MD208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
710061701OtherCIGNA
RI994OtherBLUE CROSS BLUE SHIELD
RIAA31908OtherHARVARD PILGRIM
P12037484OtherMULTIPLAN
404290OtherTUFTS
RIRG65462OtherEDS
RIRP47010OtherRITESHARE
RIZZ5973OtherMA BCBS
1200129OtherUNITED HEALTHCARE
2752OtherNEIGHBORHOOD HEALTH PLAN
000935OtherBLUECHIP