Healthcare Provider Details

I. General information

NPI: 1538553029
Provider Name (Legal Business Name): CAITLIN GREENBERG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE MAILSTOP 156SM2
BURLINGTON VT
05401
US

IV. Provider business mailing address

179 WOODBURY RD
BURLINGTON VT
05408-2451
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-2700
  • Fax:
Mailing address:
  • Phone: 978-457-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO01019
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number032.0133815
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: