Healthcare Provider Details

I. General information

NPI: 1588807408
Provider Name (Legal Business Name): MS. KEIKO IWAHARA GREENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 01/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 E MONUMENT ST STE 416
BALTIMORE MD
21287-0020
US

IV. Provider business mailing address

1830 E MONUMENT ST STE 416
BALTIMORE MD
21287-0020
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5268
  • Fax:
Mailing address:
  • Phone: 410-955-5268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD0079185
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: