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General NPI Number Information
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NPI Number | 1245328772
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Entity Type | Individual
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Provider Name | GRANT M GREENBERG MD, MA
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 1314 PETERS CREEK RD NW
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City | ROANOKE
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State | VA
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Zip | 24017-2500
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Country | US
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Telephone | 540-562-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 213 S JEFFERSON ST STE 1006
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City | ROANOKE
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State | VA
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Zip | 24011-1713
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Country | US
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Telephone |
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101287095
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301070222
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD459423
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License Number State | PA
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