Provider Demographics
NPI:1659395689
Name:GREENBERG, MARC STUART (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:STUART
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 MIAMISBURG CENTERVILLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3858
Mailing Address - Country:US
Mailing Address - Phone:937-938-6444
Mailing Address - Fax:937-834-8636
Practice Address - Street 1:1989 MIAMISBURG CENTERVILLE RD STE 200
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-3858
Practice Address - Country:US
Practice Address - Phone:937-938-6444
Practice Address - Fax:937-834-8636
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003238213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2297278Medicaid
OH2297278Medicaid
OHP00136929OtherRAILROAD MEDICARE
OH2297278Medicaid
OH4063471Medicare PIN