Provider Demographics
NPI:1154438521
Name:MARVIN H. GREENBAUM, M.D. PC
Entity type:Organization
Organization Name:MARVIN H. GREENBAUM, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATHERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-667-4066
Mailing Address - Street 1:501 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1302
Mailing Address - Country:US
Mailing Address - Phone:610-667-4066
Mailing Address - Fax:610-667-7955
Practice Address - Street 1:501 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1302
Practice Address - Country:US
Practice Address - Phone:610-667-4066
Practice Address - Fax:610-667-7955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACG3941OtherRAILROAD MEDICARE
PA1291800002Medicare NSC
PA032582Medicare PIN