Healthcare Provider Details
I. General information
NPI: 1245337245
Provider Name (Legal Business Name): DARIUS K. GREENBACHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 09/20/2006
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
300 BIRNIE AVE STE 201
SPRINGFIELD MA
01107-1121
US
IV. Provider business mailing address
300 BIRNIE AVE STE 201
SPRINGFIELD MA
01107-1121
US
V. Phone/Fax
- Phone: 413-785-4666
- Fax:
- Phone: 413-785-4666
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RS0010X |
| Taxonomy | Sports Medicine (Internal Medicine) Physician |
| License Number | 216818 |
| License Number State | MA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207P00000X |
| Taxonomy | Emergency Medicine Physician |
| License Number | 216818 |
| License Number State | MA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: