Healthcare Provider Details

I. General information

NPI: 1578502340
Provider Name (Legal Business Name): CHRISTOPHER M GREENE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 SW 1ST AVE
OCALA FL
34471-6500
US

IV. Provider business mailing address

111 COLCHESTER AVE FAHC-WP2
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-1000
  • Fax:
Mailing address:
  • Phone: 802-847-2415
  • Fax: 802-847-5324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number042-0009851
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberME139334
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: