Provider Demographics
NPI:1811954167
Name:GRECO, JOHN A (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:GRECO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4516
Mailing Address - Country:US
Mailing Address - Phone:410-644-1880
Mailing Address - Fax:410-644-0971
Practice Address - Street 1:910 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4516
Practice Address - Country:US
Practice Address - Phone:410-644-1880
Practice Address - Fax:410-646-3623
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC00003051363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC021538P53Medicare PIN
Q36684Medicare UPIN