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
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD 31800DCY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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