Healthcare Provider Details

I. General information

NPI: 1114389111
Provider Name (Legal Business Name): KEVIN ROBERT GREENE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 FLORENCE ST APT 1
NATICK MA
01760-3505
US

IV. Provider business mailing address

13 FLORENCE ST APT 1
NATICK MA
01760-3505
US

V. Phone/Fax

Practice location:
  • Phone: 978-500-9807
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number286976
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: