MEDICARE: MARK A. GREENSTEIN MD

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	2080P0006X	Developmental - Behavioral Pediatrics Physician	025582	CT

General Provider Information

NPI Number	:	1881692721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A. GREENSTEIN MD

Provider Business Mailing Address
First Line	:	1000 ASYLUM AVE
Second Line	:	SUITE 2109A
City	:	HARTFORD
State	:	CT
Zip	:	06105-1719
Country	:	US
Telephone Number	:	860-714-6581
Fax Number	:	860-714-8311

Provider Business Practice Location Address
First Line	:	1000 ASYLUM AVE
Second Line	:	SUITE 1025
City	:	HARTFORD
State	:	CT
Zip	:	06105-1719
Country	:	US
Telephone Number	:	860-714-5319
Fax Number	:	860-714-8054

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	11/29/2023

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