1881718344 NPI number — MICHAEL K GREENBERG,MD,PC

Table of content: (NPI 1881718344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881718344 NPI number — MICHAEL K GREENBERG,MD,PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL K GREENBERG,MD,PC
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:
1881718344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11637 TERRACE DRIVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
WALDORF
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20602-3707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-870-7287
Provider Business Mailing Address Fax Number:
301-870-0687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11637 TERRACE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
WALDORF
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20602-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-870-7287
Provider Business Practice Location Address Fax Number:
301-870-0687
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GREENBERG
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
301-870-7287

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  D48136 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 743302600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1932192150 . This is a "NPI DR. GREENBERG" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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