Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | MD045430L | PA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | MD045430L | PA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD045430L | PA |
N | 208200000X | Surgeon | MD045430L | PA |
N | 208600000X | Surgeon | MD045430L | PA |
NPI | 1952442378 |
---|---|
Provider Name | Dr. Timothy Marc Greco |
First Address | Bala Cynwyd, PA 19004-1501 |
Second Address | Bala Cynwyd, PA 19004-1501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 15/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F15132 | (02) |