=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750368080
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA A. GREENSPAN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 73 RUSSELL RD
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01050-9777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-667-3009
-----------------------------------------------------
Fax | 413-667-8746
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 73 RUSSELL RD
-----------------------------------------------------
City | HUNTINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01050-9777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-667-3009
-----------------------------------------------------
Fax | 413-667-8746
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 42164
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------