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General NPI Number Information
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NPI Number | 1295725885
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Entity Type | Individual
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Provider Name | PETER TEBET GREENSPAN MD
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Gender | Male
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 40 2ND AVE MASS GENERAL WEST MEDICAL GROUP STE 400
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City | WALTHAM
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State | MA
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Zip | 02451-1137
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Country | US
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Telephone | 781-487-4340
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Fax | 781-487-4341
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Provider Business Mailing Address
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Address Line | PO BOX 9142 MASS GENERAL PHYSICIAN ORGANIZATION
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City | CHARLESTOWN
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State | MA
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Zip | 02129-9142
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Country | US
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Telephone | 781-487-4340
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Fax | 781-487-4341
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 44159
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License Number State | MA
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