Provider Demographics
NPI:1225100126
Name:PAVLOVA GREENFIELD, TATIANA A (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:A
Last Name:PAVLOVA GREENFIELD
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 TEMPLETON PLACE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:301-332-9917
Mailing Address - Fax:
Practice Address - Street 1:1369 TEMPLETON PL
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1433
Practice Address - Country:US
Practice Address - Phone:301-332-9917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2246682080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine