Provider Demographics
NPI:1164425617
Name:GREENBERG, RICHARD IRVIN I (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:IRVIN
Last Name:GREENBERG
Suffix:I
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 1:11526 KEMPER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-1752
Mailing Address - Country:US
Mailing Address - Phone:513-673-5659
Mailing Address - Fax:
Practice Address - Street 1:11526 KEMPER WOODS DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-1752
Practice Address - Country:US
Practice Address - Phone:513-673-5659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.001704213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0294177Medicaid
OHGR0418891Medicare ID - Type UnspecifiedPROVIDER NUMBER
OHT80415Medicare UPIN