MEDICARE: LINDA I GREENSPAN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MB05664900	NJ
2	207Q00000X	Family Medicine Physician	2006-01488	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	144WA	OTHER	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528099462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA I GREENSPAN D.O.

Provider Business Mailing Address
First Line	:	301 S CAMPBELL ST
Second Line	:
City	:	BURGAW
State	:	NC
Zip	:	28425-5011
Country	:	US
Telephone Number	:	910-259-5721
Fax Number	:	910-259-8002

Provider Business Practice Location Address
First Line	:	301 S CAMPBELL ST
Second Line	:
City	:	BURGAW
State	:	NC
Zip	:	28425-5011
Country	:	US
Telephone Number	:	910-259-5721
Fax Number	:	910-259-8002

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	05/10/2013

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Directions to “ LINDA I GREENSPAN D.O.” Practice Location

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