1689705550 NPI number — DANIEL P GREENWALD MD PA

Table of content: (NPI 1689705550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689705550 NPI number — DANIEL P GREENWALD MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL P GREENWALD MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BAYSHORE PLASTIC SURGERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689705550
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3296
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33601-3296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-258-2425
Provider Business Mailing Address Fax Number:
813-258-1275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1208 E KENNEDY BLVD
Provider Second Line Business Practice Location Address:
SUITE 221
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33602-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-258-2425
Provider Business Practice Location Address Fax Number:
813-258-1275
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STRANAHAN
Authorized Official First Name:
CELESTE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
813-258-2425

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 45530 . This is a "BLUE CROSS & BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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