Provider Demographics
NPI:1770667388
Name:GRECO, JEFFREY M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:GRECO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:A
Other - Last Name:GURBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 S HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:MT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851
Mailing Address - Country:US
Mailing Address - Phone:570-339-2160
Mailing Address - Fax:570-339-4193
Practice Address - Street 1:300 S HICKORY ST
Practice Address - Street 2:
Practice Address - City:MT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851
Practice Address - Country:US
Practice Address - Phone:570-339-2160
Practice Address - Fax:570-339-4193
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032392E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0010545990001OtherMED ASSIST
PA02325000OtherBLUE CROSS
PAMA01054599Medicaid
1464870OtherKEYSTONE
PADA2400OtherRAILROAD MEDICARE
1464870OtherBLUE SHIELD
PADA2400OtherRAILROAD MEDICARE
PAMA01054599Medicaid