Provider Demographics
NPI:1154314326
Name:GREEN, GENE E (MD)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:E
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E EAGER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-5533
Mailing Address - Country:US
Mailing Address - Phone:410-502-8495
Mailing Address - Fax:410-522-5194
Practice Address - Street 1:1000 E EAGER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-5533
Practice Address - Country:US
Practice Address - Phone:410-502-8495
Practice Address - Fax:410-522-5194
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056934207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H08185Medicare UPIN