Healthcare Provider Details

I. General information

NPI: 1477014884
Provider Name (Legal Business Name): HEINRICH-KARL VON MOLTKE GREENBLATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 HANOVER ST
FALL RIVER MA
02720-5246
US

IV. Provider business mailing address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-1730
  • Fax: 508-973-0379
Mailing address:
  • Phone: 401-737-7010
  • Fax: 401-736-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number1019741
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD18996
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: