Provider Demographics
NPI:1689705550
Name:DANIEL P GREENWALD MD PA
Entity Type:Organization
Organization Name:DANIEL P GREENWALD MD PA
Other - Org Name:BAYSHORE PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-258-2425
Mailing Address - Street 1:PO BOX 3296
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-3296
Mailing Address - Country:US
Mailing Address - Phone:813-258-2425
Mailing Address - Fax:813-258-1275
Practice Address - Street 1:1208 E KENNEDY BLVD
Practice Address - Street 2:SUITE 221
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3504
Practice Address - Country:US
Practice Address - Phone:813-258-2425
Practice Address - Fax:813-258-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
45530OtherBLUE CROSS & BLUE SHIELD
45530OtherBLUE CROSS & BLUE SHIELD