Basic Information
Provider Information | |||||||||
NPI: | 1619904299 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GREENWALD | ||||||||
FirstName: | MELISSA | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SIPE | ||||||||
OtherFirstName: | MELISSA | ||||||||
OtherMiddleName: | A | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2 WRAMC ROOM 2J38 | ||||||||
Address2: | 6900 GEORGIA AVENUE NW | ||||||||
City: | WASHINGTON | ||||||||
State: | DC | ||||||||
PostalCode: | 203070001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2027827250 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | WRAMC GENERAL INTERNAL MEDICINE | ||||||||
Address2: | 6900 GEORGIA AVE NW | ||||||||
City: | WASHINGTON | ||||||||
State: | DC | ||||||||
PostalCode: | 203070001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2027828114 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/27/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD 31800 | DC | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.