Healthcare Provider Details

I. General information

NPI: 1659395689
Provider Name (Legal Business Name): MARC STUART GREENBERG D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 MIAMISBURG CENTERVILLE RD STE 200
DAYTON OH
45459-3858
US

IV. Provider business mailing address

1989 MIAMISBURG CENTERVILLE RD STE 200
DAYTON OH
45459-3858
US

V. Phone/Fax

Practice location:
  • Phone: 937-938-6444
  • Fax: 937-834-8636
Mailing address:
  • Phone: 937-938-6444
  • Fax: 937-834-8636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number36003238
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: