Provider Demographics
NPI:1639193709
Name:GREENE, ROBERT M (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3300 WEBSTER STREET
Mailing Address - Street 2:SUITE 410
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3117
Mailing Address - Country:US
Mailing Address - Phone:510-549-4220
Mailing Address - Fax:510-433-0744
Practice Address - Street 1:3300 WEBSTER STREET
Practice Address - Street 2:SUITE 410
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3117
Practice Address - Country:US
Practice Address - Phone:510-549-4220
Practice Address - Fax:510-433-0744
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2017-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG25204207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G252040Medicaid
CAA42570Medicare UPIN
CA00G252040Medicare ID - Type Unspecified