Provider Demographics
NPI:1487762100
Name:GREENE, BARRY S (MD FACS)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:S
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 RESERVOIR RD NW FL 4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2113
Mailing Address - Country:US
Mailing Address - Phone:202-444-4569
Mailing Address - Fax:877-376-2418
Practice Address - Street 1:3800 RESERVOIR RD NW FL 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-2000
Practice Address - Fax:877-376-2418
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043330208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD150991800Medicaid
020023644Medicare PIN
MD150991800Medicaid
133026S97Medicare PIN