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NPI Code Detail

MEDICARE: DR. MARK LOUIS GREENBERG M.D.

MEDICARE: DR. MARK LOUIS GREENBERG M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician21921AZ
2208000000XPediatrics PhysicianR7G09MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043219967
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK LOUIS GREENBERG M.D.
Provider Business Mailing Address
First Line : 4352 MANCHESTER AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2138
Country : US
Telephone Number : 314-481-1615
Fax Number : 314-531-0063
Provider Business Practice Location Address
First Line : 4352 MANCHESTER AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63110-2138
Country : US
Telephone Number : 314-481-1615
Fax Number : 314-531-0063
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 06/03/2025

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