Provider Demographics
NPI:1972727329
Name:GREENAWALD, SUSAN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ANN
Last Name:GREENAWALD
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Gender:F
Credentials:MD
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Mailing Address - Street 1:380 SIERRA COLLEGE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5081
Mailing Address - Country:US
Mailing Address - Phone:530-477-6283
Mailing Address - Fax:530-477-1450
Practice Address - Street 1:380 SIERRA COLLEGE DR
Practice Address - Street 2:STE 200
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5081
Practice Address - Country:US
Practice Address - Phone:530-477-6283
Practice Address - Fax:530-477-1450
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA653352084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH68385Medicare UPIN