Healthcare Provider Details

I. General information

NPI: 1003170861
Provider Name (Legal Business Name): STEPHEN JOHN GREENE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ERWIN RD # DUMC3845
DURHAM NC
27705-4699
US

IV. Provider business mailing address

2301 ERWIN RD # DUMC3845
DURHAM NC
27705-4699
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-8111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125061364
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2017-01297
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number2017-01297
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: