Provider Demographics
NPI:1376614610
Name:GREENWALD, ALAN EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:EDWIN
Last Name:GREENWALD
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 1:2400 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4301
Mailing Address - Country:US
Mailing Address - Phone:650-619-1779
Mailing Address - Fax:
Practice Address - Street 1:2400 GRANT ROAD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4364
Practice Address - Country:US
Practice Address - Phone:650-619-1779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA28018207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A280180Medicaid
CA00A280181Medicare ID - Type Unspecified
CAA25197Medicare UPIN