Healthcare Provider Details

I. General information

NPI: 1821630724
Provider Name (Legal Business Name): GREENWICH MEDICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W PUTNAM AVE STE 435
GREENWICH CT
06830-6086
US

IV. Provider business mailing address

2001 BUTTERFIELD RD STE 300
DOWNERS GROVE IL
60515-1069
US

V. Phone/Fax

Practice location:
  • Phone: 203-861-7890
  • Fax: 203-861-7898
Mailing address:
  • Phone: 630-725-2799
  • Fax: 833-842-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: LORENA ESPARZA
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 630-725-2764