Healthcare Provider Details

I. General information

NPI: 1912975491
Provider Name (Legal Business Name): KIRBY GREENE M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 01/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 SOUTHBRIDGE RD
NORTH OXFORD MA
01537-1142
US

IV. Provider business mailing address

26 KING ST
NORTH BROOKFIELD MA
01535-1412
US

V. Phone/Fax

Practice location:
  • Phone: 508-987-3399
  • Fax: 508-987-3595
Mailing address:
  • Phone: 508-867-6752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number412
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: