Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 0101025205 | VA |
NPI | 1043248453 |
---|---|
Provider Name | John Constantine Gretes |
First Address | Newport News, VA 23601-1318 |
Second Address | Gloucester, VA 23061-4178 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 01/03/2021 |