Healthcare Provider Details

I. General information

NPI: 1265546212
Provider Name (Legal Business Name): DAVID HUGH GREENBLOTT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 BROWN ST STE 206
HAVERHILL MA
01830-6790
US

IV. Provider business mailing address

PO BOX 208
WEST NEWBURY MA
01985-0208
US

V. Phone/Fax

Practice location:
  • Phone: 978-556-9700
  • Fax: 617-567-2121
Mailing address:
  • Phone: 978-556-9700
  • Fax: 978-521-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number2036
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: