Provider Demographics
NPI:1326160920
Name:RONALD B. GREENE, MD P.C.
Entity Type:Organization
Organization Name:RONALD B. GREENE, MD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-664-8828
Mailing Address - Street 1:225 E CITY AVE
Mailing Address - Street 2:SUITE105
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1704
Mailing Address - Country:US
Mailing Address - Phone:610-664-8828
Mailing Address - Fax:610-664-8829
Practice Address - Street 1:225 E CITY AVE
Practice Address - Street 2:SUITE105
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1704
Practice Address - Country:US
Practice Address - Phone:610-664-8828
Practice Address - Fax:610-664-8829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014521E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28360Medicare UPIN
PA039090Medicare ID - Type Unspecified