Provider Demographics
NPI:1700864683
Name:GREENE, PHILLIP SHELDON (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:SHELDON
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1418 BRICE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2397
Mailing Address - Country:US
Mailing Address - Phone:614-868-5131
Mailing Address - Fax:614-868-5180
Practice Address - Street 1:1418 BRICE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2397
Practice Address - Country:US
Practice Address - Phone:614-868-5131
Practice Address - Fax:614-868-5180
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35043686207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology