=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700110475
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY MORGAN GREENE PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2009
-----------------------------------------------------
Last Update Date | 10/24/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 MEDICAL CENTER CIR SUITE 208
-----------------------------------------------------
City | FISHERSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22939-2273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-932-5926
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 123 FOXWOOD LN
-----------------------------------------------------
City | MOUNT SIDNEY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24467-2521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-294-1337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 0110003119
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------