Provider Demographics
NPI:1447256656
Name:GREENFIELD DERMATOLOGY, P.C.
Entity type:Organization
Organization Name:GREENFIELD DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEEDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-468-4599
Mailing Address - Street 1:300 E BOYD AVE
Mailing Address - Street 2:STE 209
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-2818
Mailing Address - Country:US
Mailing Address - Phone:317-468-4599
Mailing Address - Fax:317-467-4834
Practice Address - Street 1:300 E BOYD AVE
Practice Address - Street 2:STE 209
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-2818
Practice Address - Country:US
Practice Address - Phone:317-468-4599
Practice Address - Fax:317-467-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033226207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty