MEDICARE: GLEASON & GREENFIELD PEDIATRICS, PC

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	2080A0000X	Pediatric Adolescent Medicine Physician	47757	MA

Other Identifiers

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

General Provider Information

NPI Number	:	1568514339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLEASON & GREENFIELD PEDIATRICS, PC

Provider Business Mailing Address
First Line	:	240 WAREHAM RD
Second Line	:
City	:	MARION
State	:	MA
Zip	:	02738-1175
Country	:	US
Telephone Number	:	508-748-1313
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 WAREHAM RD
Second Line	:
City	:	MARION
State	:	MA
Zip	:	02738-1175
Country	:	US
Telephone Number	:	508-748-1313
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHERYL M GREENFIELD
Credential	:	MD
Telephone Number	:	508-748-1313

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	08/22/2020

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