Provider Demographics
NPI:1710059787
Name:MARTIN T. GREANEY, M.D.
Entity Type:Organization
Organization Name:MARTIN T. GREANEY, M.D.
Other - Org Name:VENTURA MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GREANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-639-0065
Mailing Address - Street 1:5225 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4113
Mailing Address - Country:US
Mailing Address - Phone:805-639-0065
Mailing Address - Fax:805-639-0069
Practice Address - Street 1:5225 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4113
Practice Address - Country:US
Practice Address - Phone:805-639-0065
Practice Address - Fax:805-639-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A343120Medicaid
CAA34312Medicare ID - Type Unspecified
CA00A343120Medicaid