Provider Demographics
NPI:1467458331
Name:GREENBERG, PAUL B (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:B
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:ONE RANDALL SQUARE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4928
Mailing Address - Country:US
Mailing Address - Phone:401-453-4600
Mailing Address - Fax:401-453-0077
Practice Address - Street 1:ONE RANDALL SQUARE
Practice Address - Street 2:SUITE 203
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4928
Practice Address - Country:US
Practice Address - Phone:401-453-4600
Practice Address - Fax:401-453-0077
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD11177207W00000X
MA204964207W00000X
FLME71793207W00000X
LAL09682R207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA103845Medicaid
RI7010577Medicaid
RI007010577Medicare PIN
RI7010577Medicaid
MAA3157001Medicare PIN