Healthcare Provider Details

I. General information

NPI: 1487821245
Provider Name (Legal Business Name): BENJAMIN DEE GREENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARIO CAPECCHI DR DEPT. OF ANESTHESIA- PRIMARY CHILDREN'S HOSPITAL
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

1659 E WESTMINSTER AVE
SALT LAKE CITY UT
84105-3830
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-3578
  • Fax:
Mailing address:
  • Phone: 917-968-9215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number2008-00809
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number43142
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number8557253-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: