Provider Demographics
NPI:1932172194
Name:GREENE, CARLTON C (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLTON
Middle Name:C
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 1:515 FAIRMOUNT AVE
Mailing Address - Street 2:CREDENTIALING OFFICE
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5466
Mailing Address - Country:US
Mailing Address - Phone:410-494-1315
Mailing Address - Fax:410-494-7735
Practice Address - Street 1:515 FAIRMOUNT AVE
Practice Address - Street 2:STE 500
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5466
Practice Address - Country:US
Practice Address - Phone:410-494-1315
Practice Address - Fax:410-494-7735
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020780174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD761701100Medicaid
MDH596J853Medicare PIN
MDD74595Medicare UPIN
MD157676Medicare PIN
MD761701100Medicaid