Provider Demographics
NPI:1902839319
Name:GREENE, LYNNE MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:MICHELLE
Last Name:GREENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W MEETING ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2204
Mailing Address - Country:US
Mailing Address - Phone:803-285-7414
Mailing Address - Fax:803-283-4329
Practice Address - Street 1:1025 W MEETING ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2204
Practice Address - Country:US
Practice Address - Phone:803-285-7414
Practice Address - Fax:803-283-4329
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32123207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN0016AOtherMEDICAID INDIVIDUAL PROVIDER ID
SCGP0641Medicaid
SC428960OtherRHC MEDICARE LANCASTER
SC423876OtherRHC MEDICARE INDIANLAND
SCCE1315OtherMEDICARE RAILROAD GROUP#
SCRHC127OtherRHC MEDICAID LANCASTER
SCRHC211OtherRHC MEDICAID INDIANLAND
SC4754Medicare PIN
SCN0016AOtherMEDICAID INDIVIDUAL PROVIDER ID