Healthcare Provider Details

I. General information

NPI: 1073590394
Provider Name (Legal Business Name): RICHARD L GREENO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 02/27/2020
Certification Date: 02/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 MIAMI VALLEY DR
CENTERVILLE OH
45459-1221
US

IV. Provider business mailing address

20 PRESTIGE PLZ SUITE 100
MIAMISBURG OH
45342-5354
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-4658
  • Fax:
Mailing address:
  • Phone: 937-436-4658
  • Fax: 937-436-4984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number35-066921
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35066921
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: