Provider Demographics
NPI:1003899758
Name:GREENWALD, MARIA W (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:W
Last Name:GREENWALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72855 FRED WARING DR STE A6
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-9369
Mailing Address - Country:US
Mailing Address - Phone:760-341-6800
Mailing Address - Fax:760-341-9872
Practice Address - Street 1:72855 FRED WARING DR STE A6
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9369
Practice Address - Country:US
Practice Address - Phone:760-341-6800
Practice Address - Fax:760-341-9872
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49422174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G494220Medicare ID - Type Unspecified
CAA51363Medicare UPIN