Provider Demographics
NPI:1134153885
Name:GREENBERG, JEFFREY O (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:O
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 1:101 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4054
Mailing Address - Country:US
Mailing Address - Phone:781-291-3042
Mailing Address - Fax:857-343-8192
Practice Address - Street 1:101 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4054
Practice Address - Country:US
Practice Address - Phone:781-291-3042
Practice Address - Fax:857-343-8192
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227342207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine