Provider Demographics
NPI:1053530329
Name:PHILLIP S. GREENE, M.D., IINC.
Entity type:Organization
Organization Name:PHILLIP S. GREENE, M.D., IINC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:SHELDON
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-863-1759
Mailing Address - Street 1:638 INDIAN MOUND RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2635
Mailing Address - Country:US
Mailing Address - Phone:614-863-1759
Mailing Address - Fax:614-863-1759
Practice Address - Street 1:638 INDIAN MOUND RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2635
Practice Address - Country:US
Practice Address - Phone:614-863-1759
Practice Address - Fax:614-863-1759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-3686-G207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty