Provider Demographics
NPI:1326063587
Name:GREENBERG, JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GREENBERG
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 1:11119 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3143
Mailing Address - Country:US
Mailing Address - Phone:301-468-9225
Mailing Address - Fax:301-770-2863
Practice Address - Street 1:11119 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 310
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3143
Practice Address - Country:US
Practice Address - Phone:301-468-9225
Practice Address - Fax:301-770-2863
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059573208000000X
DCMD32764208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC009646C95Medicare ID - Type UnspecifiedDC MEDICARE
DCH62832Medicare UPIN