MEDICARE: DR. LAWRENCE HOWARD GREENBLATT M.D.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	207R00000X	Internal Medicine Physician	NC94-00812	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NC94-00812	OTHER	NC	NC LICENSE NUMBER

General Provider Information

NPI Number	:	1629019971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE HOWARD GREENBLATT M.D.D

Provider Business Mailing Address
First Line	:	1110 MINERVA AVE
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27701-2031
Country	:	US
Telephone Number	:	919-688-4139
Fax Number	:	919-477-3110

Provider Business Practice Location Address
First Line	:	4220 N ROXBORO ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27704-1826
Country	:	US
Telephone Number	:	919-471-8344
Fax Number	:	919-477-3110

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	07/08/2007

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