Provider Demographics
NPI:1083666390
Name:GREENFELD, BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:GREENFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2512 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1651 NE BENTLEY DR
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-3706
Practice Address - Country:US
Practice Address - Phone:360-782-3400
Practice Address - Fax:360-782-3440
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016842207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GR7943OtherREGENCE BLUE SHIELD
WA8223414Medicaid
4313088OtherAETNA
WA8927125OtherCRIME VICTIMS COMP
WA120369OtherLABOR & INDUSTRIES
AG8398871OtherDEA
WAG8852197Medicare PIN
4313088OtherAETNA
WA8223414Medicaid
WAGAB03324Medicare PIN
WA8927125OtherCRIME VICTIMS COMP
WAGAB03323Medicare PIN
WAGAB03322Medicare PIN