Provider Demographics
NPI:1629034616
Name:MARVIN E GREENBERG MD PA
Entity Type:Organization
Organization Name:MARVIN E GREENBERG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-726-2080
Mailing Address - Street 1:7421 N UNIVERSITY DRIVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2952
Mailing Address - Country:US
Mailing Address - Phone:954-726-2080
Mailing Address - Fax:954-726-2105
Practice Address - Street 1:7421 N UNIVERSITY DRIVE
Practice Address - Street 2:SUITE 109
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2952
Practice Address - Country:US
Practice Address - Phone:954-726-2080
Practice Address - Fax:954-726-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36221207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL79535OtherBLUE SHIELD OF FLORIDA
FL79535OtherBLUE SHIELD OF FLORIDA
FLD58834Medicare UPIN