Healthcare Provider Details

I. General information

NPI: 1467458331
Provider Name (Legal Business Name): PAUL B GREENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE RANDALL SQUARE SUITE 203
PROVIDENCE RI
02904-4928
US

IV. Provider business mailing address

ONE RANDALL SQUARE SUITE 203
PROVIDENCE RI
02904-4928
US

V. Phone/Fax

Practice location:
  • Phone: 401-453-4600
  • Fax: 401-453-0077
Mailing address:
  • Phone: 401-453-4600
  • Fax: 401-453-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD11177
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number204964
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME71793
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberL09682R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: