Provider Demographics
NPI:1750589917
Name:GREENAGE, MICHAEL PAUL (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:GREENAGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2900 TYLER RD
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6374
Mailing Address - Country:US
Mailing Address - Phone:540-731-7311
Mailing Address - Fax:540-731-7377
Practice Address - Street 1:2900 TYLER RD
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6374
Practice Address - Country:US
Practice Address - Phone:540-731-7311
Practice Address - Fax:540-731-7377
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS0155242084P0800X
VA01160196862084P0800X
VA0102-2036792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVB891AOtherMEDICARE PTAN