=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477765964
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW JAY GREENBERG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 10/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 FISHER RD
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05602-9516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-371-4263
-----------------------------------------------------
Fax | 802-371-4481
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 547 CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT
-----------------------------------------------------
City | BARRE
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05641-0547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-371-4263
-----------------------------------------------------
Fax | 802-371-4481
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 5620
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 0420012005
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------