Provider Demographics
NPI:1235202680
Name:GREANEY, MARTIN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:THOMAS
Last Name:GREANEY
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 1:5225 TELEGRAPH ROAD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-639-0065
Mailing Address - Fax:805-639-0069
Practice Address - Street 1:5225 TELEGRAPH ROAD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-639-0065
Practice Address - Fax:805-639-0069
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A343120Medicaid
CAA34312Medicare ID - Type Unspecified
A27446Medicare UPIN