Healthcare Provider Details

I. General information

NPI: 1932148681
Provider Name (Legal Business Name): LINDA GREENBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 CHELTENHAM AVE.
ELKINS PARK PA
19027
US

IV. Provider business mailing address

1939 CHELTENHAM AVE.
ELKINS PARK PA
19027
US

V. Phone/Fax

Practice location:
  • Phone: 215-884-5715
  • Fax:
Mailing address:
  • Phone: 215-884-5715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD072456
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: