Provider Demographics
NPI:1528093788
Name:GREER, STEVEN WILLIAMMUNDKUR (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:WILLIAMMUNDKUR
Last Name:GREER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:WILLIAM
Other - Last Name:GREER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:109 OAK ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1492
Mailing Address - Country:US
Mailing Address - Phone:617-244-8664
Mailing Address - Fax:617-244-8674
Practice Address - Street 1:150 PARK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2517
Practice Address - Country:US
Practice Address - Phone:978-685-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA707862080P0006X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3014177Medicaid
MA3014177Medicaid