Healthcare Provider Details

I. General information

NPI: 1386957876
Provider Name (Legal Business Name): DANIEL PHILLIP GREENE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 MIDLOTHIAN TPKE SUITE 127
NORTH CHESTERFIELD VA
23235-4700
US

IV. Provider business mailing address

4600 COX RD SUITE 120
GLEN ALLEN VA
23060-6708
US

V. Phone/Fax

Practice location:
  • Phone: 804-897-1510
  • Fax: 804-897-1692
Mailing address:
  • Phone: 804-270-0330
  • Fax: 804-270-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA130722
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101257472
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: