Healthcare Provider Details

I. General information

NPI: 1164450003
Provider Name (Legal Business Name): THOMAS J GREENWOOD PA, NP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NEVIN AVE
RICHMOND CA
94801-3143
US

IV. Provider business mailing address

616 COLUSA AVE
BERKELEY CA
94707-1518
US

V. Phone/Fax

Practice location:
  • Phone: 510-307-2452
  • Fax: 510-307-2463
Mailing address:
  • Phone: 510-307-2452
  • Fax: 510-307-2463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number14825
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number,374060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: