Provider Demographics
NPI:1619978756
Name:GREENE, JOSHUA M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:M
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 1:2701 HOLME AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2029
Mailing Address - Country:US
Mailing Address - Phone:215-335-3088
Mailing Address - Fax:215-335-0315
Practice Address - Street 1:2701 HOLME AVE STE 303
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2029
Practice Address - Country:US
Practice Address - Phone:215-335-3088
Practice Address - Fax:215-335-0315
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD428569207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1245881OtherAETNA
PA1016174650001Medicaid
PA2690993000OtherKEYSTONE HEALTH PLAN EAST
PAGR1835374OtherHIGHMARK
PABG9259498Medicare UPIN
PA1016174650001Medicaid