Healthcare Provider Details

I. General information

NPI: 1154322238
Provider Name (Legal Business Name): JAY B GREENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 PROFESSIONAL CT
HAGERSTOWN MD
21740-5852
US

IV. Provider business mailing address

1130 PROFESSIONAL CT
HAGERSTOWN MD
21740-5852
US

V. Phone/Fax

Practice location:
  • Phone: 301-791-5555
  • Fax: 301-791-8104
Mailing address:
  • Phone: 301-791-5555
  • Fax: 301-791-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD021545
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: