Provider Demographics
NPI:1164090775
Name:GREENE, TOMEKA (PA-C)
Entity Type:Individual
Prefix:
First Name:TOMEKA
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:2808 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3685
Mailing Address - Country:US
Mailing Address - Phone:717-920-4400
Mailing Address - Fax:717-920-4401
Practice Address - Street 1:121 N NYES RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-3247
Practice Address - Country:US
Practice Address - Phone:717-531-8674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA062692363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical