Basic Information
| Provider Information | |||||||||
| NPI: | 1457326076 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREENSPAN | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | Z | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 MILK ST | ||||||||
| Address2: | PROVIDER ENROLLMENT - 9TH FLOOR | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021094806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175598374 | ||||||||
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| Practice Location | |||||||||
| Address1: | 291 INDEPENDENCE DR | ||||||||
| Address2: | INTERNAL MEDICINE | ||||||||
| City: | CHESTNUT HILL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024673628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175416615 | ||||||||
| FaxNumber: | 6175416444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 11/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 71133 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | AA29967 | 01 | MA | HARVARD PILGRIM | OTHER | 071133 | 01 | MA | TUFTS | OTHER | 3047628 | 05 | MA | MEDICAID | J08401 | 01 | MA | BLUE CROSS | OTHER |