Provider Demographics
NPI:1184628901
Name:GREENMAN, MAXWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:
Last Name:GREENMAN
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 1:2801 RANDOLPH RD
Mailing Address - Street 2:STE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1047
Mailing Address - Country:US
Mailing Address - Phone:704-375-2101
Mailing Address - Fax:
Practice Address - Street 1:2801 RANDOLPH RD
Practice Address - Street 2:STE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1047
Practice Address - Country:US
Practice Address - Phone:704-375-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18873207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8937154Medicaid
SC365373Medicaid
5387460001Medicare NSC
NCC84176Medicare UPIN
NC2337986Medicare PIN