Provider Demographics
NPI:1154483303
Name:GINZBURG, HAROLD M (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:M
Last Name:GINZBURG
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 1:100 S BLISS AVE
Mailing Address - Street 2:DEPT OF PSYCHIATRY
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-2512
Mailing Address - Country:US
Mailing Address - Phone:504-858-0066
Mailing Address - Fax:504-613-4913
Practice Address - Street 1:100 S BLISS AVE
Practice Address - Street 2:DEPT OF PSYCHIATRY
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-2512
Practice Address - Country:US
Practice Address - Phone:504-858-0066
Practice Address - Fax:504-613-4913
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK258652084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA99610Medicaid
LA5Y315Medicare ID - Type Unspecified
LA99610Medicaid