Provider Demographics
NPI:1629060868
Name:GREENE, JAMES EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
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 1:100 ARROW SPRINGS BLVD
Mailing Address - Street 2:SUITE 2700
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9864
Mailing Address - Country:US
Mailing Address - Phone:513-282-7911
Mailing Address - Fax:513-282-7900
Practice Address - Street 1:100 ARROW SPRINGS BLVD
Practice Address - Street 2:SUITE 2700
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9864
Practice Address - Country:US
Practice Address - Phone:513-282-7911
Practice Address - Fax:513-282-7900
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0791479Medicaid
OHE58353Medicare UPIN
OH0673915Medicare PIN