Provider Demographics
NPI:1770976813
Name:ROBERT A GREENBERG MD PA
Entity type:Organization
Organization Name:ROBERT A GREENBERG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRE
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-331-1155
Mailing Address - Street 1:6628 NW 9TH BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4282
Mailing Address - Country:US
Mailing Address - Phone:352-331-1155
Mailing Address - Fax:352-331-3371
Practice Address - Street 1:6628 NW 9TH BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4282
Practice Address - Country:US
Practice Address - Phone:352-331-1155
Practice Address - Fax:352-331-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME13988207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053664400Medicaid
FL01906Medicare UPIN