Healthcare Provider Details

I. General information

NPI: 1932193729
Provider Name (Legal Business Name): ADAM SCOTT GREENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12497 TAMIAMI TRL S STE 1
NORTH PORT FL
34287-1415
US

IV. Provider business mailing address

12497 TAMIAMI TRL S STE 1
NORTH PORT FL
34287-1415
US

V. Phone/Fax

Practice location:
  • Phone: 941-282-3376
  • Fax: 941-282-3378
Mailing address:
  • Phone: 941-282-3376
  • Fax: 941-282-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME75565
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME75565
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: