Provider Demographics
NPI:1003819731
Name:GREINER, LARRY (DPM)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:GREINER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3943
Mailing Address - Country:US
Mailing Address - Phone:740-353-6911
Mailing Address - Fax:740-353-2950
Practice Address - Street 1:802 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3943
Practice Address - Country:US
Practice Address - Phone:740-353-6911
Practice Address - Fax:740-353-2950
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36001616213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0187882Medicaid
OH480022202OtherRAILROAD MEDICARE
OH0373844Medicare PIN