Provider Demographics
NPI:1851369300
Name:GREENBERG, BRENT GEOFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:GEOFFREY
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 1:1130 NEW GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3206
Mailing Address - Country:US
Mailing Address - Phone:336-218-1102
Mailing Address - Fax:336-218-0145
Practice Address - Street 1:1130 NEW GARDEN RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-3206
Practice Address - Country:US
Practice Address - Phone:336-218-1102
Practice Address - Fax:336-218-0145
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61854207Q00000X
VA0101248774207Q00000X
NC2008-01798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG50343Medicare UPIN
CAWA61854AMedicare ID - Type Unspecified