Provider Demographics
NPI:1811098379
Name:GREENE, BRADLEY ALAN (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ALAN
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3130 ALPINE RD
Mailing Address - Street 2:SUITE 195
Mailing Address - City:PORTOLA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94028-7549
Mailing Address - Country:US
Mailing Address - Phone:650-851-0155
Mailing Address - Fax:650-529-0929
Practice Address - Street 1:3130 ALPINE RD
Practice Address - Street 2:SUITE 195
Practice Address - City:PORTOLA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94028-7549
Practice Address - Country:US
Practice Address - Phone:650-851-0155
Practice Address - Fax:650-529-0929
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2013-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA74002207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery