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General NPI Number Information
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NPI Number | 1144318916
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Entity Type | Individual
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Provider Name | JERRY GREENE M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/31/2009
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Provider Practice Location Address
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Address Line | 1400 VFW PKWY C/O MEDICAL SERVICE 111
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City | WEST ROXBURY
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State | MA
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Zip | 02132
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Country | US
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Telephone | 617-323-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 95 SAWYER RD
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City | WALTHAM
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State | MA
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Zip | 02453-3471
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Country | US
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Telephone | 781-392-2008
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Fax | 781-642-8867
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 45681
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License Number State | MA
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