Provider Demographics
NPI:1932192150
Name:GREENBERG, MICHAEL K (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11637 TERRACE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3706
Mailing Address - Country:US
Mailing Address - Phone:301-870-7287
Mailing Address - Fax:301-870-0687
Practice Address - Street 1:11637 TERRACE DR
Practice Address - Street 2:STE 100
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3706
Practice Address - Country:US
Practice Address - Phone:301-870-7287
Practice Address - Fax:301-870-0687
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD481362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD743302600Medicaid
MD743302600Medicaid
E77047Medicare UPIN