Individual
KIMBERLY MARIE GREENWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(919) 784-3034
Mailing address
PO BOX 18139, RALEIGH, NC 27619-8139
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
36717
NC
207LP2900X
Pain Medicine (Anesthesiology) Physician
36717
NC
208VP0014X
Interventional Pain Medicine Physician
36717
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050047832
RAILROAD-MEDICARE
NC
01
—
132EN
BCBS NC
NC
01
—
20283
PARTNERS
NC
01
—
57298
MEDCOST
NC
01
—
6724459
CIGNA
NC
05
—
89132EN
—
NC
Enumeration date
08/31/2006
Last updated
03/30/2021
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