Healthcare Provider Details

I. General information

NPI: 1881653152
Provider Name (Legal Business Name): LAWRENCE L GREENWALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 MILFORD ST
UPTON MA
01568-1309
US

IV. Provider business mailing address

236 MILFORD ST
UPTON MA
01568-1309
US

V. Phone/Fax

Practice location:
  • Phone: 508-473-1015
  • Fax:
Mailing address:
  • Phone: 508-473-1015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number81064
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: