Provider Demographics
NPI:1376506527
Name:GREENE, ROBERT THOMAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THOMAS
Last Name:GREENE
Suffix:JR
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 1:1453 35TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-2321
Mailing Address - Country:US
Mailing Address - Phone:202-584-9239
Mailing Address - Fax:202-584-7744
Practice Address - Street 1:1453 35TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2321
Practice Address - Country:US
Practice Address - Phone:202-584-9239
Practice Address - Fax:202-584-7744
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC17491207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCE-22200Medicare UPIN
DCGR551260Medicare ID - Type UnspecifiedIDENTIFICATION NUMBER