Provider Demographics
NPI:1215985874
Name:GREENE, CHARLES WILLIAM JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:WILLIAM
Last Name:GREENE
Suffix:JR
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 1:534 WOODS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607
Mailing Address - Country:US
Mailing Address - Phone:864-720-2739
Mailing Address - Fax:864-720-2740
Practice Address - Street 1:534 WOODS LAKE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2778
Practice Address - Country:US
Practice Address - Phone:864-720-2739
Practice Address - Fax:864-720-2740
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17998207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576007863131OtherBCBS OF SC
SC5296584OtherAETNA
SC576007863127OtherBLUE CHOICE OF SC
SC9212323OtherCIGNA
SC179988Medicaid
SCG210936904Medicare PIN
SC9212323OtherCIGNA
SC5296584OtherAETNA