Provider Demographics
NPI:1275533218
Name:GREENSPAN, MITCHELL MILES (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:MILES
Last Name:GREENSPAN
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 1:3 LIFE MARK DR
Mailing Address - Street 2:
Mailing Address - City:SELLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18960-1598
Mailing Address - Country:US
Mailing Address - Phone:215-257-1127
Mailing Address - Fax:215-257-0129
Practice Address - Street 1:3 LIFE MARK DR
Practice Address - Street 2:
Practice Address - City:SELLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18960-1598
Practice Address - Country:US
Practice Address - Phone:215-257-1127
Practice Address - Fax:215-257-0129
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016431E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009485220002Medicaid
PAGR153711OtherBLUE SHIELD
B40050Medicare UPIN
PA0009485220002Medicaid