Provider Demographics
NPI:1790817575
Name:GREENBLATT, JAMES MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARK
Last Name:GREENBLATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9 HOPE AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-2751
Mailing Address - Country:US
Mailing Address - Phone:781-647-2901
Mailing Address - Fax:781-647-6753
Practice Address - Street 1:9 HOPE AVE STE 500
Practice Address - Street 2:WALDEN BEHAVIORAL CARE
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453-2751
Practice Address - Country:US
Practice Address - Phone:781-647-0066
Practice Address - Fax:781-899-4905
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2016-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA703332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70333OtherLICENSE
MARX2645OtherMEDICARE
MARX2645OtherMEDICARE
MAE69633Medicare UPIN