Provider Demographics
NPI:1568543288
Name:GREENSPAN, PHILIP E (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:E
Last Name:GREENSPAN
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 1:501 KINGS HWY E
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4867
Mailing Address - Country:US
Mailing Address - Phone:203-610-6300
Mailing Address - Fax:203-610-6347
Practice Address - Street 1:501 KINGS HWY E
Practice Address - Street 2:SUITE 204
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4867
Practice Address - Country:US
Practice Address - Phone:203-610-6300
Practice Address - Fax:203-610-6347
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043568207RP1001X, 207RC0200X, 207RS0012X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001435686Medicaid
CT110010057Medicare PIN
CT001435686Medicaid