Provider Demographics
NPI:1184810533
Name:GREENBAUM, JORDAN N (MD, MBA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:N
Last Name:GREENBAUM
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:300 BIRNIE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1107
Mailing Address - Country:US
Mailing Address - Phone:413-785-4666
Mailing Address - Fax:413-846-4756
Practice Address - Street 1:300 BIRNIE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1107
Practice Address - Country:US
Practice Address - Phone:413-785-4666
Practice Address - Fax:413-846-4756
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA235658207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery