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GREENBRAE DERMATOLOGY, A MEDICAL CORPORATION
NPI 1174898654
Dermatology in Greenbrae, CA

Active since March 15, 2012CLIA 05D0686425 · Certificate of Compliance
1300 S ELISEO DR STE 207, GREENBRAE, CA 94904(415) 925-0550(415) 925-9062 Get Directions Write a Review

NPPES record last updated: June 30, 2015. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Greenbrae Dermatology, A Medical Corporation NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GREENBRAE DERMATOLOGY, A MEDICAL CORPORATION (NPI 1174898654) is a healthcare organization registered as a dermatology in Greenbrae, California and active in the NPI registry since March 2012. The organization holds a CLIA Certificate of Compliance certificate valid through December 31, 2026 and lists Lucretia Ann Lewitt, Practice Manager, as its authorized official.

NPPES Registry Identity

NPI1174898654
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameGREENBRAE DERMATOLOGY, A MEDICAL CORPORATION
Location Address1300 S ELISEO DR STE 207Greenbrae, CA 94904-2015
Mailing Address1300 S Eliseo Dr Ste 207Greenbrae, CA 94904-2015 · (415) 925-0550 · Fax (415) 925-9062
Phone(415) 925-0550
Fax(415) 925-9062
Organization SubpartNo
Authorized OfficialLucretia Ann LewittPractice Manager · (415) 925-0550
Enumeration DateMarch 15, 2012
Last NPPES UpdateJune 30, 2015
✔ NPI 1174898654 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Licenses✔ Licensed in CA · G53455✔ Licensed in CA · A97783✔ Licensed in CA · G40606
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X · License A97783 (CA)
Also ListedDermatology · DermatopathologyTaxonomy 207ND0900X · License G53455 (CA), A97783 (CA)
Also ListedDermatology · Pediatric DermatologyTaxonomy 207NP0225X · License G53455 (CA), A97783 (CA), G40606 (CA)
Also ListedDermatology · Procedural DermatologyTaxonomy 207NS0135X · License G53455 (CA), A97783 (CA), G40606 (CA)
1300 S ELISEO DR STE 207, Greenbrae, CA 94904
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 05D0686425

Greenbrae Dermatology Amc · Greenbrae, CA
Active · expires Dec 31, 2026
CLIA Number05D0686425
Laboratory TypePhysician Office
Certificate Effective DateJanuary 1, 2025
Certificate Expiration DateDecember 31, 2026
Laboratory DirectorDr. Benjamin Nichols
Laboratory Phone(415) 925-0550
Laboratory LocationGreenbrae Dermatology Amc501 Sir Francis Drake Blvd, Ste 200, Greenbrae, CA 94904
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOHN L. MADDOX MD
Dermatology
1300 S ELISEO DR STE 207
GREENBRAE, CA 94904
Marin County (415) 925-0550

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Greenbrae Dermatology, A Medical Corporation's NPI number?

The NPI number for Greenbrae Dermatology, A Medical Corporation is 1174898654. It was assigned to this organization in the NPPES registry on March 15, 2012.

Where is Greenbrae Dermatology, A Medical Corporation located?

Greenbrae Dermatology, A Medical Corporation is located at 1300 S Eliseo Dr Ste 207, Greenbrae, CA 94904. The listed phone number is (415) 925-0550.

What is Greenbrae Dermatology, A Medical Corporation's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Greenbrae Dermatology, A Medical Corporation hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 05D0686425) is associated with this NPI, valid through December 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Greenbrae Dermatology, A Medical Corporation was last updated on June 30, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.