Provider Demographics
NPI:1922259324
Name:GREENWOOD, DONNA LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:LYNNE
Last Name:GREENWOOD
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 1:43 BAXTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-1894
Mailing Address - Country:US
Mailing Address - Phone:207-879-3040
Mailing Address - Fax:207-879-3947
Practice Address - Street 1:43 BAXTER BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1894
Practice Address - Country:US
Practice Address - Phone:207-879-3040
Practice Address - Fax:207-879-3947
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM429101Medicare PIN