MEDICARE: RONALD B. GREENE, MD P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD014521E	PA

General Provider Information

NPI Number	:	1326160920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD B. GREENE, MD P.C.

Provider Business Mailing Address
First Line	:	225 E CITY AVE
Second Line	:	SUITE105
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1704
Country	:	US
Telephone Number	:	610-664-8828
Fax Number	:	610-664-8829

Provider Business Practice Location Address
First Line	:	225 E CITY AVE
Second Line	:	SUITE105
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-1704
Country	:	US
Telephone Number	:	610-664-8828
Fax Number	:	610-664-8829

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RONALD BARRY GREENE
Credential	:	M.D.
Telephone Number	:	610-664-8828

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	11/27/2007

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