1831176593 NPI number — WILLAIM R. GREENBERG MD LLC

Table of content: (NPI 1831176593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831176593 NPI number — WILLAIM R. GREENBERG MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLAIM R. GREENBERG MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831176593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 W BAY DR
Provider Second Line Business Mailing Address:
SUITE 431
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33770-3269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-549-8107
Provider Business Mailing Address Fax Number:
727-549-8720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 W BAY DR
Provider Second Line Business Practice Location Address:
SUITE 431
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33770-3269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-549-8107
Provider Business Practice Location Address Fax Number:
727-549-8720
Provider Enumeration Date:
12/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GREENBERG
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
727-549-8107

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  ME39777 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 130000533 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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