Provider Demographics
NPI:1770704744
Name:LORENZ-GREENBERG, CAROLYN SARAH (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:SARAH
Last Name:LORENZ-GREENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:LORENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:CENTRAL VERMONT MEDICAL CENTER - FINANCE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-371-5950
Mailing Address - Fax:802-371-5951
Practice Address - Street 1:246 GRANGER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-0000
Practice Address - Country:US
Practice Address - Phone:802-371-5950
Practice Address - Fax:802-371-5951
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5584208000000X
VT0420012009208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD9001Medicaid
VT1017749Medicaid
AKMD9001Medicaid