Provider Demographics
NPI:1629019971
Name:GREENBLATT, LAWRENCE HOWARD (MDD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:HOWARD
Last Name:GREENBLATT
Suffix:
Gender:M
Credentials:MDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 MINERVA AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27701-2031
Mailing Address - Country:US
Mailing Address - Phone:919-688-4139
Mailing Address - Fax:919-477-3110
Practice Address - Street 1:4220 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1826
Practice Address - Country:US
Practice Address - Phone:919-471-8344
Practice Address - Fax:919-477-3110
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC94-00812207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC94-00812OtherNC LICENSE NUMBER
NCNC94-00812OtherNC LICENSE NUMBER