Provider Demographics
NPI:1952321127
Name:GREENBERG, ABRAHAM JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:JOSEPH
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 45TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6103
Mailing Address - Country:US
Mailing Address - Phone:206-522-6640
Mailing Address - Fax:206-527-0147
Practice Address - Street 1:7301 45TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6103
Practice Address - Country:US
Practice Address - Phone:206-522-6640
Practice Address - Fax:206-527-0147
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP000000439213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0161920133OtherPACIFICARE PROVIDER #
WA1056126Medicaid
WA141177001OtherGROUP HEALTH PROVIDER #
WAGR4489OtherBLUE CROSS RIDER NUMBER
WA0195472OtherL&I
WA0195472OtherL&I
WA141177001OtherGROUP HEALTH PROVIDER #