Provider Demographics
NPI:1053379537
Name:GREENE, DWAYNE ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:ERIC
Last Name:GREENE
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 1:825 10TH ST NW APT 1179
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-5096
Mailing Address - Country:US
Mailing Address - Phone:678-536-3607
Mailing Address - Fax:
Practice Address - Street 1:SENTARA CAREPLEX HOSPITAL
Practice Address - Street 2:3000 COLISEUM DRIVE
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666
Practice Address - Country:US
Practice Address - Phone:757-736-2008
Practice Address - Fax:757-736-1029
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057630207P00000X
MA74892207P00000X
TN51588207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA533972530AMedicaid
MA074892OtherTUFTS
MA3083411Medicaid
MAJ11666OtherBS
MA3083411Medicaid
GA533972530AMedicaid