Provider Demographics
NPI:1437161668
Name:GREENBERGER, MATTHEW L (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:L
Last Name:GREENBERGER
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 1:1801 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2607
Mailing Address - Country:US
Mailing Address - Phone:714-693-1915
Mailing Address - Fax:714-693-1127
Practice Address - Street 1:1801 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2607
Practice Address - Country:US
Practice Address - Phone:714-693-1915
Practice Address - Fax:714-693-1127
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70624208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H29512Medicare UPIN
CAWA70624AMedicare PIN
CAA70624Medicare ID - Type Unspecified