Provider Demographics
NPI:1972653384
Name:GREENBERG, SCOTT R (MD)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:R
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 S. BRYN MAWR AVE
Mailing Address - Street 2:300A
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3124
Mailing Address - Country:US
Mailing Address - Phone:833-440-4325
Mailing Address - Fax:484-380-2115
Practice Address - Street 1:101 S. BRYN MAWR AVE
Practice Address - Street 2:300A
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3124
Practice Address - Country:US
Practice Address - Phone:833-440-4325
Practice Address - Fax:484-380-2115
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA69121207Q00000X
PAMD065771L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ22-3005391OtherTAX ID
NJ22-3005391OtherTAX ID