Healthcare Provider Details

I. General information

NPI: 1558350504
Provider Name (Legal Business Name): CRAIG A. GREENE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1781 TATE BLVD SE SUITE 203
HICKORY NC
28602-4251
US

IV. Provider business mailing address

PO BOX 601067
CHARLOTTE NC
28260-1067
US

V. Phone/Fax

Practice location:
  • Phone: 704-373-0212
  • Fax: 704-342-5871
Mailing address:
  • Phone: 704-373-0212
  • Fax: 704-342-5871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number35906
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number13616
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: