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General NPI Number Information
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NPI Number | 1891806634
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Entity Type | Individual
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Provider Name | KIMBERLY MARIE GREENWALD MD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 4420 LAKE BOONE TRL
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City | RALEIGH
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State | NC
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Zip | 27607-7505
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Country | US
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Telephone | 919-784-3034
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 18139
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City | RALEIGH
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State | NC
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Zip | 27619-8139
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 36717
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 36717
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 36717
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License Number State | NC
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