Provider Demographics
NPI:1386653335
Name:GREENBAUM, BARBARA H (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:H
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9234
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:1012 LAUREL OAK RD STE 1014
Practice Address - Street 2:SPECIALTY CENTER AT VOORHEES
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3505
Practice Address - Country:US
Practice Address - Phone:856-435-7502
Practice Address - Fax:856-627-2183
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021678E208000000X, 2080P0207X
NJ25MA0403420208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0373605Medicaid
PA001637572Medicaid
PA003564Medicare ID - Type Unspecified
PA001637572Medicaid
NJ0373605Medicaid