Healthcare Provider Details

I. General information

NPI: 1770654550
Provider Name (Legal Business Name): MARC STEVEN GREENBLATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

14 MOSS GLEN LN
SOUTH BURLINGTON VT
05403-7274
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-8400
  • Fax:
Mailing address:
  • Phone: 802-660-9466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number042-0009106
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: