Healthcare Provider Details

I. General information

NPI: 1477934149
Provider Name (Legal Business Name): SCOTT A. GREENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20101 LAKE CHABOT RD
CASTRO VALLEY CA
94546-5305
US

IV. Provider business mailing address

20101 LAKE CHABOT RD FL 4
CASTRO VALLEY CA
94546-5305
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-1844
  • Fax: 510-506-7729
Mailing address:
  • Phone: 510-204-8168
  • Fax: 510-537-1883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA167540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: