Healthcare Provider Details

I. General information

NPI: 1932450806
Provider Name (Legal Business Name): SUSAN GREENBERG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 WISCONSIN AVE NW SUITE 402
WASHINGTON DC
20015-2014
US

IV. Provider business mailing address

1925 LAKEPORT WAY
RESTON VA
20191-5427
US

V. Phone/Fax

Practice location:
  • Phone: 202-237-7000
  • Fax:
Mailing address:
  • Phone: 304-920-1962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1020464
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024170088
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: