MEDICARE: MARVIN E GREENBERG MD PA

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	207W00000X	Ophthalmology Physician	ME36221	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	79535	OTHER	FL	BLUE SHIELD OF FLORIDA

General Provider Information

NPI Number	:	1629034616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARVIN E GREENBERG MD PA

Provider Business Mailing Address
First Line	:	7421 N UNIVERSITY DRIVE
Second Line	:	SUITE 109
City	:	TAMARAC
State	:	FL
Zip	:	33321-2952
Country	:	US
Telephone Number	:	954-726-2080
Fax Number	:	954-726-2105

Provider Business Practice Location Address
First Line	:	7421 N UNIVERSITY DRIVE
Second Line	:	SUITE 109
City	:	TAMARAC
State	:	FL
Zip	:	33321-2952
Country	:	US
Telephone Number	:	954-726-2080
Fax Number	:	954-726-2105

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARVIN E GREENBERG
Credential	:	MD
Telephone Number	:	954-726-2080

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	02/07/2008

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