Provider Demographics
NPI:1124006754
Name:GREENWALD, MICHELE F (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:F
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 1:111 GROSSMAN DR
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4997
Mailing Address - Country:US
Mailing Address - Phone:781-849-2300
Mailing Address - Fax:781-849-2377
Practice Address - Street 1:111 GROSSMAN DR
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4997
Practice Address - Country:US
Practice Address - Phone:781-849-2300
Practice Address - Fax:781-849-2377
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81760208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0015204OtherNEIGHBORHOOD HEALTH
MAPP859OtherHARVARD PILGRIM
MA081760OtherTUFTS
MA3154751Medicaid
MAJ17000OtherBLUE CROSS
MAB10460202OtherCIGNA
MA0015204OtherNEIGHBORHOOD HEALTH
MAPP859OtherHARVARD PILGRIM