Basic Information
| Provider Information | |||||||||
| NPI: | 1558464370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENSTON | ||||||||
| FirstName: | MATHEW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MCGREGOR ST | ||||||||
| Address2: | EMERGENCY DEPT | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031023730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036636472 | ||||||||
| FaxNumber: | 6039262853 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 MCGREGOR ST | ||||||||
| Address2: | CMC - EMERGENCY DEPARTMENT | ||||||||
| City: | MANCHESTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 031023730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036636478 | ||||||||
| FaxNumber: | 6039262853 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 10/27/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 11246 | NH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30206501 | 05 | NH | MEDICAID | 4129232 | 01 | MVP | OTHER | 2130700 | 05 | MA | MEDICAID | 000000042678 | 01 | BMC HEALTHNET PLAN | OTHER | AA79987 | 01 | HARVARD PILGRIM | OTHER | 01Y003100NH03 | 01 | NH | ANTHEM | OTHER | 434911199 | 05 | ME | MEDICAID | P00384959 | 01 | RAILROAD MEDICARE | OTHER |