Provider Demographics
NPI:1043313430
Name:MICHAEL A GREENE MD PA
Entity type:Organization
Organization Name:MICHAEL A GREENE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:301-963-0040
Mailing Address - Street 1:19640 CLUB HOUSE RD
Mailing Address - Street 2:#410
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886
Mailing Address - Country:US
Mailing Address - Phone:301-963-0040
Mailing Address - Fax:301-840-1504
Practice Address - Street 1:19640 CLUB HOUSE RD
Practice Address - Street 2:#410
Practice Address - City:MONTGOMERY VILLAGE
Practice Address - State:MD
Practice Address - Zip Code:20886
Practice Address - Country:US
Practice Address - Phone:301-963-0040
Practice Address - Fax:301-840-1504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C87906Medicare UPIN
GR083442Medicare ID - Type Unspecified