Provider Demographics
NPI:1750334843
Name:GREENSPAN, BENNETT STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:BENNETT
Middle Name:STEVEN
Last Name:GREENSPAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1120 15TH ST
Mailing Address - Street 2:RADIOLOGY DEPARTMENT
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-9729
Mailing Address - Fax:706-721-8507
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-9729
Practice Address - Fax:706-772-1850
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA045408002085R0202X
GA0687392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I303748OtherGA MEDICARE