Provider Demographics
NPI:1407875883
Name:GREENE, RALPH L (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:L
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:704-302-9300
Mailing Address - Fax:704-302-9301
Practice Address - Street 1:4525 CAMERON VALLEY PKWY
Practice Address - Street 2:SUITE 3100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-4369
Practice Address - Country:US
Practice Address - Phone:704-302-9300
Practice Address - Fax:704-302-9301
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC19057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC37065OtherBCBS OF NC
110229133OtherMEDICARE RAILROAD
SCN19057Medicaid
NC8937065Medicaid
110229133OtherMEDICARE RAILROAD
NC8937065Medicaid
NC37065OtherBCBS OF NC