Provider Demographics
NPI:1255503363
Name:GREENBERG, SCOTT M (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:GREENBERG
Suffix:
Gender:M
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:PO BOX 11390
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4004
Mailing Address - Country:US
Mailing Address - Phone:866-949-1433
Mailing Address - Fax:
Practice Address - Street 1:24231 WALDEN CENTER DR STE 201
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:34134
Practice Address - Country:US
Practice Address - Phone:239-348-4221
Practice Address - Fax:239-390-2486
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9310207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherBC/BS
FL280947800Medicaid
FL3140636OtherCIGNA
FL318102OtherAVMED
FLPENDINGOtherAETNA
FLAL596ZMedicare PIN