Provider Demographics
NPI:1508812413
Name:GREENBAUM, MAURICE (MD)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:GREENBAUM
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:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970
Mailing Address - Country:US
Mailing Address - Phone:978-825-6581
Mailing Address - Fax:978-825-7070
Practice Address - Street 1:55 HIGHLAND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970
Practice Address - Country:US
Practice Address - Phone:978-741-1644
Practice Address - Fax:978-744-3468
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44158207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2068397Medicaid
D78151Medicare ID - Type Unspecified
D82812Medicare UPIN