Provider Demographics
NPI:1093760563
Name:GREENSPAN, GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:GREENSPAN
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 1:255 S. 17TH ST.
Mailing Address - Street 2:SUITE 2900
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19103
Mailing Address - Country:US
Mailing Address - Phone:215-545-3530
Mailing Address - Fax:215-545-7011
Practice Address - Street 1:255 S 17TH ST
Practice Address - Street 2:SUITE 2900
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19103-6231
Practice Address - Country:US
Practice Address - Phone:215-545-3530
Practice Address - Fax:215-545-7011
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025458E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA153930Medicare ID - Type Unspecified
PAB40072Medicare UPIN