Healthcare Provider Details

I. General information

NPI: 1093712218
Provider Name (Legal Business Name): CHERYL MARSHA GREENFIELD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WAREHAM RD
MARION MA
02738-1175
US

IV. Provider business mailing address

240 WAREHAM RD
MARION MA
02738-1175
US

V. Phone/Fax

Practice location:
  • Phone: 508-748-1313
  • Fax:
Mailing address:
  • Phone: 508-748-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number47757
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: