Provider Demographics
NPI:1063765865
Name:GREENE, TODD STUART (PA-C)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:STUART
Last Name:GREENE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1792 ALYSHEBA WAY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2288
Mailing Address - Country:US
Mailing Address - Phone:859-335-9041
Mailing Address - Fax:859-422-6917
Practice Address - Street 1:1792 ALYSHEBA WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2288
Practice Address - Country:US
Practice Address - Phone:859-335-9041
Practice Address - Fax:859-422-6917
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA102363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant