Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 74805 | MA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 074805 | MA |
NPI | 1780690248 |
---|---|
Provider Name | Dr. Elliot Bruce Greenberg |
First Address | Springfield, MA 01107 |
Second Address | Springfield, MA 01107-1270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 13/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3195422 | (05) | MA |
D03526 | (02) | MA |