Provider Demographics
NPI:1235497827
Name:GREENE, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:GREENE
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 1:9707 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-965-0546
Mailing Address - Fax:202-877-3699
Practice Address - Street 1:9707 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-965-0546
Practice Address - Fax:202-877-3699
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2018-10-25
Deactivation Date:2018-10-19
Deactivation Code:
Reactivation Date:2018-10-24
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0085394208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program