Healthcare Provider Details

I. General information

NPI: 1992796262
Provider Name (Legal Business Name): STANLEY H GREENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 RICHLAND MEDICAL PARK SUITE 500
COLUMBIA SC
29203-6859
US

IV. Provider business mailing address

9 RICHLAND MEDICAL PARK SUITE 500
COLUMBIA SC
29203-6859
US

V. Phone/Fax

Practice location:
  • Phone: 803-254-0670
  • Fax: 803-254-4595
Mailing address:
  • Phone: 803-254-0670
  • Fax: 803-254-4595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberSC10135
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: