Provider Demographics
NPI:1144220385
Name:GREENBERG, LARISA (MD)
Entity type:Individual
Prefix:DR
First Name:LARISA
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LARISA
Other - Middle Name:
Other - Last Name:CHEREDNIKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:247 MOREWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1861
Mailing Address - Country:US
Mailing Address - Phone:412-622-0290
Mailing Address - Fax:
Practice Address - Street 1:314 E NORTH AVE
Practice Address - Street 2:LEVEL ONE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4756
Practice Address - Country:US
Practice Address - Phone:412-325-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058740L207RX0202X
FLME107123207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002139Medicaid
PA001610210Medicaid
OH2443252Medicaid
FLDO233ZMedicare PIN
PA237316Medicare PIN