Provider Demographics
NPI:1073620472
Name:GREENBAUM, MARVIN H (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:H
Last Name:GREENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1302
Mailing Address - Country:US
Mailing Address - Phone:610-667-4066
Mailing Address - Fax:610-667-7955
Practice Address - Street 1:501 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1302
Practice Address - Country:US
Practice Address - Phone:610-667-4066
Practice Address - Fax:610-667-7955
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026860E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0045485000OtherKEYSTONE
PA180038454OtherRAILROAD MEDICARE
PA2156912OtherAETNA
PA426804OtherBLUE SHIELD
PA0045485000OtherPERSONAL CHOICE
PAAMERIHEALTHOther0045485000
PA0045485000OtherKEYSTONE
PAAMERIHEALTHOther0045485000
PA2156912OtherAETNA