Provider Demographics
NPI:1447274667
Name:GRECO, KATHLEEN MARY (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:GRECO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 SWANTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2039
Mailing Address - Country:US
Mailing Address - Phone:781-729-6869
Mailing Address - Fax:617-332-4974
Practice Address - Street 1:77 SWANTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2039
Practice Address - Country:US
Practice Address - Phone:781-729-6869
Practice Address - Fax:617-332-4974
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA057881174400000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE28833Medicare UPIN
MAJ09207Medicare ID - Type Unspecified