Provider Demographics
NPI:1023457256
Name:GREENE, MATTHEW WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:WAYNE
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 1:204 WEST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:JB CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29492
Mailing Address - Country:US
Mailing Address - Phone:843-963-6683
Mailing Address - Fax:
Practice Address - Street 1:204 WEST HILL BLVD
Practice Address - Street 2:
Practice Address - City:JB CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29492
Practice Address - Country:US
Practice Address - Phone:843-963-6683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-02517207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine