Provider Demographics
NPI:1497869903
Name:GREENE, KENNETH MYRON (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:MYRON
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 1:3407 GARRISON FARMS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1852
Mailing Address - Country:US
Mailing Address - Phone:410-653-3731
Mailing Address - Fax:
Practice Address - Street 1:6701 N CHARLES ST STE 4104
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6808
Practice Address - Country:US
Practice Address - Phone:410-821-2800
Practice Address - Fax:410-821-2804
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine