Healthcare Provider Details

I. General information

NPI: 1922056308
Provider Name (Legal Business Name): KENT S. GREENWOOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 03/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WHALON STREET SUITE 1-D
FITCHBURG MA
01420
US

IV. Provider business mailing address

104 WHALON STREET SUITE 1-D
FITCHBURG MA
01420
US

V. Phone/Fax

Practice location:
  • Phone: 978-345-0050
  • Fax: 978-345-0064
Mailing address:
  • Phone: 978-345-0050
  • Fax: 978-345-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number74865
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: