Provider Demographics
NPI:1871533422
Name:GREENBERG, MICHAEL A
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:A
Other - Last Name:GREENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:56 NEWTOWN RICHBORO RD
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1700
Mailing Address - Country:US
Mailing Address - Phone:215-322-4139
Mailing Address - Fax:215-396-8550
Practice Address - Street 1:56 NEWTOWN RICHBORO RD
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1700
Practice Address - Country:US
Practice Address - Phone:215-322-4139
Practice Address - Fax:215-396-8550
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001508L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0050137301OtherAMERICHOICE
PA0023120001OtherKEYSTONE HEALTH PLAN
PA1146565002OtherCIGNA HMO
PAPO38460OtherCHAMPUS
PAGR108040OtherBLUE CROSS BLUE SHIELD
PA0501373Medicaid
PAPO38460OtherCHAMPUS
PAT28733Medicare UPIN