Provider Demographics
NPI:1487844742
Name:HAROLD L GREENBERG MD PA
Entity Type:Organization
Organization Name:HAROLD L GREENBERG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-682-4600
Mailing Address - Street 1:PO BOX 161477
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-1477
Mailing Address - Country:US
Mailing Address - Phone:407-682-4600
Mailing Address - Fax:407-682-4647
Practice Address - Street 1:875 CONCOURSE PKWY SOUTH
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-6147
Practice Address - Country:US
Practice Address - Phone:407-682-4600
Practice Address - Fax:407-682-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0012290207RC0000X
CAG 00018312207RC0000X
VA0101235166207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1710948377OtherNPI
FLD64213Medicare UPIN