Healthcare Provider Details

I. General information

NPI: 1558327031
Provider Name (Legal Business Name): JOHN R. GREENE III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 COLUMBUS CORNERS DR
WHITEVILLE NC
28472-4929
US

IV. Provider business mailing address

251 HARRY S TRUMAN DR APT 31
LARGO MD
20774-2044
US

V. Phone/Fax

Practice location:
  • Phone: 202-368-6793
  • Fax:
Mailing address:
  • Phone: 202-368-6793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberD0059112
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35352
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: