Healthcare Provider Details

I. General information

NPI: 1629019971
Provider Name (Legal Business Name): LAWRENCE HOWARD GREENBLATT M.D.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 N ROXBORO ST
DURHAM NC
27704-1826
US

IV. Provider business mailing address

1110 MINERVA AVE
DURHAM NC
27701-2031
US

V. Phone/Fax

Practice location:
  • Phone: 919-471-8344
  • Fax: 919-477-3110
Mailing address:
  • Phone: 919-688-4139
  • Fax: 919-477-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberNC94-00812
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: