Healthcare Provider Details

I. General information

NPI: 1528099462
Provider Name (Legal Business Name): LINDA I GREENSPAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S CAMPBELL ST
BURGAW NC
28425-5011
US

IV. Provider business mailing address

301 S CAMPBELL ST
BURGAW NC
28425-5011
US

V. Phone/Fax

Practice location:
  • Phone: 910-259-5721
  • Fax: 910-259-8002
Mailing address:
  • Phone: 910-259-5721
  • Fax: 910-259-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB05664900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2006-01488
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: