Healthcare Provider Details

I. General information

NPI: 1942395207
Provider Name (Legal Business Name): STEVEN S GREENBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 WALNUT ST SUITE 1101 DERMATOLOGIC SURGICAL ASSOC
PHILADELPHIA PA
19102
US

IV. Provider business mailing address

1528 WALNUT ST SUITE 1101
PHILADELPHIA PA
19102
US

V. Phone/Fax

Practice location:
  • Phone: 215-735-4994
  • Fax: 215-735-8473
Mailing address:
  • Phone: 215-735-4994
  • Fax: 215-735-8376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD041412E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: