Provider Demographics
NPI:1851503684
Name:GREENWALD, RICHARD (MA, DPM, MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:GREENWALD
Suffix:
Gender:M
Credentials:MA, DPM, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 JEFFERY STREET
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-4139
Mailing Address - Country:US
Mailing Address - Phone:561-314-8968
Mailing Address - Fax:561-995-5640
Practice Address - Street 1:799 JEFFERY STREET
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-4139
Practice Address - Country:US
Practice Address - Phone:561-314-8968
Practice Address - Fax:561-995-5640
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1240213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00087657Medicare ID - Type UnspecifiedMEDICARE NUMBER
FLU05653Medicare UPIN