Healthcare Provider Details

I. General information

NPI: 1952893125
Provider Name (Legal Business Name): JOSHUA MICHAEL GREENWALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date: 12/17/2020
Reactivation Date: 01/13/2021

III. Provider practice location address

400 RUSSELL AVE BLDG 41
NEW ORLEANS LA
70143-5077
US

IV. Provider business mailing address

400 RUSSELL AVE BLDG 41
NEW ORLEANS LA
70143-5077
US

V. Phone/Fax

Practice location:
  • Phone: 504-697-9250
  • Fax:
Mailing address:
  • Phone: 504-697-9250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101267698
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101267698
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: