Provider Demographics
NPI:1770742587
Name:GREENE, JONATHAN BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:BENJAMIN
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 OLD ROAD TO 9 ACRE COR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4181
Mailing Address - Country:US
Mailing Address - Phone:978-287-8767
Mailing Address - Fax:978-287-8766
Practice Address - Street 1:131 OLD ROAD TO 9 ACRE COR
Practice Address - Street 2:SUITE 330
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4181
Practice Address - Country:US
Practice Address - Phone:978-287-8767
Practice Address - Fax:978-287-8766
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2015-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA263152207RC0000X
NY259802207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease