Provider Demographics
NPI:1699726927
Name:GREENBERG, PHILLIP H (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:H
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 LAZAR PL
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5672
Mailing Address - Country:US
Mailing Address - Phone:843-667-1553
Mailing Address - Fax:843-662-4749
Practice Address - Street 1:1408 LAZAR PL
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501
Practice Address - Country:US
Practice Address - Phone:843-667-1553
Practice Address - Fax:843-662-4749
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9508208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1457301848OtherGROUP NPI
SCC609470281Medicare PIN
SC1457301848OtherGROUP NPI