Provider Demographics
NPI:1992099733
Name:LAWRENCE S GREENBERG M.D. A PROFESSIONAL CORP
Entity type:Organization
Organization Name:LAWRENCE S GREENBERG M.D. A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-832-2697
Mailing Address - Street 1:1360 W 6TH ST STE 185
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90732-3536
Mailing Address - Country:US
Mailing Address - Phone:310-832-2697
Mailing Address - Fax:310-832-0662
Practice Address - Street 1:1360 W 6TH ST STE 185
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-3536
Practice Address - Country:US
Practice Address - Phone:310-832-2697
Practice Address - Fax:310-832-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-08
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19929208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA40791Medicare UPIN