Healthcare Provider Details

I. General information

NPI: 1104802636
Provider Name (Legal Business Name): MARTHA M. GREENWOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST SUITE 200
HARTFORD CT
06106
US

IV. Provider business mailing address

111 FOUNDERS PLAZA SUITE 400
EAST HARTFORD CT
06108
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-6589
  • Fax: 860-560-2849
Mailing address:
  • Phone: 860-291-6554
  • Fax: 860-783-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number029247
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: