Provider Demographics
NPI:1205843893
Name:GREENE, ROBERT JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:GREENE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 PARK AVE
Mailing Address - Street 2:SUITE 803
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1953
Mailing Address - Country:US
Mailing Address - Phone:508-757-3803
Mailing Address - Fax:508-757-8011
Practice Address - Street 1:255 PARK AVE
Practice Address - Street 2:SUITE 803
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1953
Practice Address - Country:US
Practice Address - Phone:508-757-3803
Practice Address - Fax:508-757-8011
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA2121213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9709690Medicaid
MA5091810001Medicare NSC
MAY75072Medicare PIN
MAU77817Medicare UPIN