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General NPI Number Information
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NPI Number | 1629019971
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Entity Type | Individual
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Provider Name | LAWRENCE HOWARD GREENBLATT M.D.D
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Gender | Male
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4220 N ROXBORO ST
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City | DURHAM
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State | NC
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Zip | 27704-1826
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Country | US
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Telephone | 919-471-8344
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Fax | 919-477-3110
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Provider Business Mailing Address
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Address Line | 1110 MINERVA AVE
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City | DURHAM
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State | NC
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Zip | 27701-2031
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Country | US
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Telephone | 919-688-4139
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Fax | 919-477-3110
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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 | NC94-00812
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License Number State | NC
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