Provider Demographics
NPI:1801889274
Name:GREENBAUM, BRAD ANDREW (MD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:ANDREW
Last Name:GREENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 21ST AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1848
Mailing Address - Country:US
Mailing Address - Phone:615-327-9371
Mailing Address - Fax:615-329-6652
Practice Address - Street 1:342 21ST AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1848
Practice Address - Country:US
Practice Address - Phone:615-327-9371
Practice Address - Fax:615-329-6652
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30181208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00001807489 01OtherUNITEDHEALTHCARE
TN079138OtherAETNA
TNG75193OtherHEALTHSPRINGS
TN110784OtherCIGNA
TN3101080OtherBLUE CROSS
TN3824681Medicaid
TNG75193Medicare UPIN
TNG75193Medicare UPIN