Provider Demographics
NPI:1053301226
Name:GREENBERG, DONNA BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:BETH
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-2984
Mailing Address - Fax:617-726-5946
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:WRN 6
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-2984
Practice Address - Fax:617-726-5946
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40648207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB11642OtherBCBS MA
MA040648OtherTUFTS HEALTH PLAN
MA0134848Medicaid
B72845Medicare UPIN
MAB11642Medicare ID - Type Unspecified