Provider Demographics
NPI:1558350504
Name:GREENE, CRAIG A (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
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:PO BOX 601067
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1067
Mailing Address - Country:US
Mailing Address - Phone:704-373-0212
Mailing Address - Fax:704-342-5871
Practice Address - Street 1:1781 TATE BLVD SE
Practice Address - Street 2:SUITE 203
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4251
Practice Address - Country:US
Practice Address - Phone:704-373-0212
Practice Address - Fax:704-342-5871
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC359062080P0202X
SC136162080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8937041Medicaid
NC1558350504Medicaid
SCN35906Medicaid
NC1558350504Medicaid
NCNC3457DMedicare PIN
F38382Medicare UPIN
SCN35906Medicaid
SCSC18318186Medicare PIN
NCNC3457AMedicare PIN
NCNC3457BMedicare PIN
NCNC3457CMedicare PIN