Provider Demographics
NPI:1124074372
Name:GREENES, DAVID S (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:GREENES
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 1:75 WARE RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-1821
Mailing Address - Country:US
Mailing Address - Phone:781-455-6764
Mailing Address - Fax:
Practice Address - Street 1:111 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2900
Practice Address - Country:US
Practice Address - Phone:781-444-7186
Practice Address - Fax:781-449-4617
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79518174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7264692OtherCIGNA
MA3871474OtherAETNA
MAAA12465OtherHPHC
MAJ17075OtherBCBS
MA079518OtherTUFTS
MA3164403Medicaid
MA079518OtherTUFTS