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General NPI Number Information
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NPI Number | 1164468120
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Entity Type | Individual
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Provider Name | GARY A GREENSPAN MD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 06/13/2024
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Provider Practice Location Address
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Address Line | 4200 WARRRENSVILLE CNTR ROAD #200
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City | WARRENSVILLE HTS
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State | OH
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Zip | 44122
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Country | US
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Telephone | 216-752-7676
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Fax | 216-295-8041
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Provider Business Mailing Address
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Address Line | PO BOX 660
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City | MENTOR
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State | OH
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Zip | 44061-0660
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Country | US
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Telephone | 440-854-0217
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Fax | 440-516-3783
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 054667
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License Number State | OH
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