Provider Demographics
NPI:1235497827
Name:GREENE, JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 TOWN CENTER PKWY STE 463
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3300
Mailing Address - Country:US
Mailing Address - Phone:571-910-7878
Mailing Address - Fax:571-910-7868
Practice Address - Street 1:1850 TOWN CENTER PKWY STE 463
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3300
Practice Address - Country:US
Practice Address - Phone:571-910-7878
Practice Address - Fax:571-910-7868
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2024-09-27
Deactivation Date:2018-10-19
Deactivation Code:
Reactivation Date:2018-10-24
Provider Licenses
StateLicense IDTaxonomies
VA0101262805208600000X
MDD0085394208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery