1881653152 NPI number — DR. LAWRENCE L GREENWALD MD

Table of content: DR. LAWRENCE L GREENWALD MD (NPI 1881653152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881653152 NPI number — DR. LAWRENCE L GREENWALD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENWALD
Provider First Name:
LAWRENCE
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1881653152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
236 MILFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01568-1309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-473-1015
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
236 MILFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01568-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-473-1015
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  81064 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0006230 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3138321 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J31274 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 081064 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 300472 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060057793 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43556 . This is a "FALLON" identifier . This identifiers is of the category "OTHER".




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