MEDICARE: LAWRENCE 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
1	207Y00000X	Otolaryngology Physician	MD430986	PA

General Provider Information

NPI Number	:	1477675742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE GREENBERG M.D.

Provider Business Mailing Address
First Line	:	291 IRONWOOD CIR
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-1317
Country	:	US
Telephone Number	:	215-885-8265
Fax Number	:	215-885-5672

Provider Business Practice Location Address
First Line	:	291 IRONWOOD CIR
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-1317
Country	:	US
Telephone Number	:	215-885-8265
Fax Number	:	215-885-5672

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2007
Last Update Date	:	01/10/2019

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