Provider Demographics
NPI:1083642219
Name:GREENFIELD, BRUCE G (DPM)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:G
Last Name:GREENFIELD
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 1:2800 W TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5215
Mailing Address - Country:US
Mailing Address - Phone:610-449-3344
Mailing Address - Fax:610-789-6753
Practice Address - Street 1:2800 W TOWNSHIP LINE RD
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5215
Practice Address - Country:US
Practice Address - Phone:610-449-3344
Practice Address - Fax:610-789-6753
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002317-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0816700001OtherDME
PA0008501870001Medicaid
PA0008501870001Medicaid
PA058590Medicare PIN
PA0816700001OtherDME