Provider Demographics
NPI:1942206495
Name:GREYBUSH, MARY THERESA (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:THERESA
Last Name:GREYBUSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7996 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2241
Mailing Address - Country:US
Mailing Address - Phone:215-728-1411
Mailing Address - Fax:
Practice Address - Street 1:7996 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2241
Practice Address - Country:US
Practice Address - Phone:215-728-1411
Practice Address - Fax:215-745-7578
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009279L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA040213Medicare PIN