Healthcare Provider Details

I. General information

NPI: 1326547704
Provider Name (Legal Business Name): ANDREW TODD GREENE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2018
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E MAXWELL ST STE 140
LEXINGTON KY
40508-2678
US

IV. Provider business mailing address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-0005
  • Fax: 859-323-0790
Mailing address:
  • Phone: 336-716-4039
  • Fax: 336-716-6937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2022-01849
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number60058
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: