Provider Demographics
NPI:1922020841
Name:GREENBERG, JACOB J (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:J
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:PO BOX 641683
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15264
Mailing Address - Country:US
Mailing Address - Phone:412-232-8111
Mailing Address - Fax:412-485-5250
Practice Address - Street 1:1400 LOCUST ST
Practice Address - Street 2:MERCY HOSPITAL OF PITTSBURGH
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219
Practice Address - Country:US
Practice Address - Phone:412-232-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036356L2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0789982OtherOHIO MEDICAID
PA1227982OtherCIGNA
PA141909OtherHIGHMARK BS PA
PA4230992OtherAETNA
PA1500853OtherGATEWAY
PA0126308OtherUNISON
PA201048OtherUPMC
PA422296OtherHEALTH AMERICA
PA0006515590003Medicaid
PA422296OtherHEALTH AMERICA