Healthcare Provider Details

I. General information

NPI: 1598769028
Provider Name (Legal Business Name): HERBERT E. GREENMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 RANDOLPH RD STE 200
CHARLOTTE NC
28211-1047
US

IV. Provider business mailing address

2801 RANDOLPH RD STE 200
CHARLOTTE NC
28211-1047
US

V. Phone/Fax

Practice location:
  • Phone: 704-375-2101
  • Fax: 704-375-2107
Mailing address:
  • Phone: 704-375-2101
  • Fax: 704-375-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number200400503
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: