Provider Demographics
NPI:1104026210
Name:GREENE, NORMAN XAVIER (MD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:XAVIER
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 1:1125 RUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-9488
Mailing Address - Country:US
Mailing Address - Phone:937-599-3538
Mailing Address - Fax:937-599-4712
Practice Address - Street 1:1125 RUSH AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311
Practice Address - Country:US
Practice Address - Phone:937-599-3538
Practice Address - Fax:937-599-4712
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245150207V00000X
OH35.122880207V00000X
SD9015207V00000X
NJ25MA09116700207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02924647Medicaid
OH0358394Medicaid
OH1292058OtherCIGNA (OHIO)
NY481384OtherWELLCARE
NY8647U2OtherBLUE CROSS BLUE SHIELD
NYP3835207OtherOXFORD
NY9028095OtherAETNA
NY02924647Medicaid
OH1104026210OtherMEDICAL MUTUAL OF OHIO