=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104802636
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARTHA M. GREENWOOD M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2005
-----------------------------------------------------
Last Update Date | 10/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 85 SEYMOUR ST SUITE 200
-----------------------------------------------------
City | HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-246-6589
-----------------------------------------------------
Fax | 860-560-2849
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 FOUNDERS PLAZA SUITE 400
-----------------------------------------------------
City | EAST HARTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-291-6554
-----------------------------------------------------
Fax | 860-783-5733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 029247
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------