Provider Demographics
NPI:1619998366
Name:GREENE, SHIRLEY R (MD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:R
Last Name:GREENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 PLYMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-1510
Mailing Address - Country:US
Mailing Address - Phone:781-767-4207
Mailing Address - Fax:781-767-4281
Practice Address - Street 1:39 PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:MA
Practice Address - Zip Code:02343-1510
Practice Address - Country:US
Practice Address - Phone:781-767-4207
Practice Address - Fax:781-767-4281
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA43495207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA043495OtherTUFTS
MAD14274OtherBLUE CROSS/BLUE SHIELD
MA0051709001OtherCIGNA
MA2067471Medicaid
MA6545OtherHARVARD PILGRIM HEALTH
MA04-02041OtherUNITED HEALTHCARE
MAB97392Medicare UPIN
MAD14274OtherBLUE CROSS/BLUE SHIELD