MEDICARE: ROGER A GREENWALD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	C335960	CA

General Provider Information

NPI Number	:	1124223482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER A GREENWALD M.D.

Provider Business Mailing Address
First Line	:	909 SAN RAMON VALLEY BLVD
Second Line	:	#114
City	:	DANVILLE
State	:	CA
Zip	:	94526-4038
Country	:	US
Telephone Number	:	925-837-6428
Fax Number	:	925-837-1403

Provider Business Practice Location Address
First Line	:	909 SAN RAMON VALLEY BLVD
Second Line	:	#114
City	:	DANVILLE
State	:	CA
Zip	:	94526-4038
Country	:	US
Telephone Number	:	925-837-6428
Fax Number	:	925-837-1403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	07/08/2007

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