Provider Demographics
NPI:1114161429
Name:GREENBERG, KATHRYN LAUREN-ZOE (DO)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:LAUREN-ZOE
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 COSEY BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-4612
Mailing Address - Country:US
Mailing Address - Phone:203-494-5821
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-494-5821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0517682085R0202X
WAOP605148772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology