Provider Demographics
NPI:1952391856
Name:GREENE, MARTIN L (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
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:PO BOX 3489
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98114-3489
Mailing Address - Country:US
Mailing Address - Phone:206-386-9500
Mailing Address - Fax:206-386-9605
Practice Address - Street 1:515 MINOR AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2120
Practice Address - Country:US
Practice Address - Phone:206-386-9500
Practice Address - Fax:206-386-9605
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00010750207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA78906OtherL & I
WA101161947OtherRR MEDICARE
WA1329804Medicaid
A04596Medicare UPIN
WA000179602Medicare ID - Type Unspecified