Provider Demographics
NPI:1861432403
Name:MCCLINTOCK GREENBERG, ANDREW (MD, PHD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MCCLINTOCK GREENBERG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 30TH ST
Mailing Address - Street 2:STE.520
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3424
Mailing Address - Country:US
Mailing Address - Phone:510-465-6800
Mailing Address - Fax:510-268-0634
Practice Address - Street 1:350 30TH ST
Practice Address - Street 2:STE.520
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3424
Practice Address - Country:US
Practice Address - Phone:510-465-6800
Practice Address - Fax:510-268-0634
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71504207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A715040Medicaid
CA00A715040Medicare ID - Type UnspecifiedANDREW GREENBERG, M.D.
CA00A715040Medicaid