Provider Demographics
NPI:1932306032
Name:MATTHEW L GREENBERGER MD PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MATTHEW L GREENBERGER MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-936-1915
Mailing Address - Street 1:1801 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2607
Mailing Address - Country:US
Mailing Address - Phone:714-639-1915
Mailing Address - Fax:714-639-1127
Practice Address - Street 1:1801 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2607
Practice Address - Country:US
Practice Address - Phone:714-639-1915
Practice Address - Fax:714-639-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21013Medicare PIN