Provider Demographics
NPI:1932390499
Name:GREENMAN, ELLEN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:ANN
Last Name:GREENMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2959 RICHARD AVE
Mailing Address - Street 2:
Mailing Address - City:CAYUCOS
Mailing Address - State:CA
Mailing Address - Zip Code:93430-1507
Mailing Address - Country:US
Mailing Address - Phone:805-995-3994
Mailing Address - Fax:
Practice Address - Street 1:2959 RICHARD AVE
Practice Address - Street 2:
Practice Address - City:CAYUCOS
Practice Address - State:CA
Practice Address - Zip Code:93430-1507
Practice Address - Country:US
Practice Address - Phone:805-995-3994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG078384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine