Provider Demographics
NPI:1396700845
Name:GREENFIELD, JAMES C (DO)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:GREENFIELD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W FRACK ST
Mailing Address - Street 2:
Mailing Address - City:FRACKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17931-1719
Mailing Address - Country:US
Mailing Address - Phone:570-794-6123
Mailing Address - Fax:570-794-6124
Practice Address - Street 1:40 W FRACK ST
Practice Address - Street 2:
Practice Address - City:FRACKVILLE
Practice Address - State:PA
Practice Address - Zip Code:17931-1719
Practice Address - Country:US
Practice Address - Phone:570-794-6123
Practice Address - Fax:570-794-6124
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007679L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019096450006Medicaid
PA196646OtherMEDICARE ID (NEW)
PAF84498Medicare UPIN
PA064358Medicare ID - Type UnspecifiedMEDICARE