Provider Demographics
NPI:1285619650
Name:GREENE, JOHN DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:STE 208
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-3302
Mailing Address - Fax:716-332-3525
Practice Address - Street 1:5290 MILITARY RD
Practice Address - Street 2:SUITE 8
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1953
Practice Address - Country:US
Practice Address - Phone:716-297-9379
Practice Address - Fax:716-297-4638
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2009-11-27
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Provider Licenses
StateLicense IDTaxonomies
NY126103207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00743577Medicaid
NYB36039Medicare UPIN
NY00743577Medicaid
NYC77041Medicare PIN