Healthcare Provider Details

I. General information

NPI: 1619998366
Provider Name (Legal Business Name): SHIRLEY R GREENE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 PLYMOUTH ST
HOLBROOK MA
02343-1510
US

IV. Provider business mailing address

39 PLYMOUTH ST
HOLBROOK MA
02343-1510
US

V. Phone/Fax

Practice location:
  • Phone: 781-767-4207
  • Fax: 781-767-4281
Mailing address:
  • Phone: 781-767-4207
  • Fax: 781-767-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number43495
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: