Healthcare Provider Details

I. General information

NPI: 1780690248
Provider Name (Legal Business Name): ELLIOT BRUCE GREENBERG M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL CENTER DR SUITE 206
SPRINGFIELD MA
01107-1270
US

IV. Provider business mailing address

354 BIRNIE AVENUE BAYSTATE OB GYN GROUP INC
SPRINGFIELD MA
01107
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-8484
  • Fax: 413-794-8477
Mailing address:
  • Phone: 413-784-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number074805
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number74805
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: