Provider Demographics
NPI:1326233370
Name:GREENE, HARRY LEE (M D)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:LEE
Last Name:GREENE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3725
Mailing Address - Street 2:
Mailing Address - City:WEST SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42564-3725
Mailing Address - Country:US
Mailing Address - Phone:561-317-3387
Mailing Address - Fax:606-451-9728
Practice Address - Street 1:205 WAITSBORO DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-8715
Practice Address - Country:US
Practice Address - Phone:561-317-3387
Practice Address - Fax:606-451-9728
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38863208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics