Healthcare Provider Details

I. General information

NPI: 1083174916
Provider Name (Legal Business Name): ELIZABETH GREENWALD MD, MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE # RABB2
BOSTON MA
02215-5400
US

IV. Provider business mailing address

330 BROOKLINE AVE # RABB2
BOSTON MA
02215-5400
US

V. Phone/Fax

Practice location:
  • Phone: 617-667-1029
  • Fax:
Mailing address:
  • Phone: 617-667-1029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1015451
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: