Provider Demographics
NPI:1760407738
Name:GREENBERG, LAWRENCE STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:STEPHEN
Last Name:GREENBERG
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 1:1360 W 6TH ST STE 185
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3536
Mailing Address - Country:US
Mailing Address - Phone:310-832-2697
Mailing Address - Fax:310-832-0662
Practice Address - Street 1:1360 W 6TH ST STE 185
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3536
Practice Address - Country:US
Practice Address - Phone:310-832-2697
Practice Address - Fax:310-832-0662
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19929208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G199290Medicaid
CA00G199290Medicaid
CAG19929Medicare ID - Type Unspecified