Provider Demographics
NPI:1932193729
Name:GREENBERG, ADAM SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:SCOTT
Last Name:GREENBERG
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 1:12497 TAMIAMI TRL S STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-1415
Mailing Address - Country:US
Mailing Address - Phone:941-282-3376
Mailing Address - Fax:941-282-3378
Practice Address - Street 1:12497 TAMIAMI TRL S STE 1
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1415
Practice Address - Country:US
Practice Address - Phone:941-282-3376
Practice Address - Fax:941-282-3378
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75565207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070015729OtherMEDICARE RR
FL921321379OtherTAX ID
FL44796OtherBCBS
FLG80775Medicare UPIN
FLE1279YMedicare ID - Type Unspecified