Healthcare Provider Details

I. General information

NPI: 1740280031
Provider Name (Legal Business Name): CHARLOTTE S. GREENE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HOSPITAL DR
YORK ME
03909-1011
US

IV. Provider business mailing address

15 HOSPITAL DR THEBAUD BUILDING, FOURTH FLOOR
YORK ME
03909-1011
US

V. Phone/Fax

Practice location:
  • Phone: 207-351-2478
  • Fax: 207-351-2216
Mailing address:
  • Phone: 973-267-2293
  • Fax: 973-267-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1549
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: