Active NPI
Donald Richard Greene, MD
- Dermatology Physician
- Madison, CT
National Provider Identifier
1629040886
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 018276
- Practice address
- 80 Randi Dr
Madison, CT 06443-2462 - Phone
- (203) 444-1227
- Fax
- (203) 444-1227
- NPI assigned
- Feb 2, 2006
- Last updated
- Sep 25, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 018276 | CT | Primary |
Addresses
Primary practice location
80 Randi Dr
Madison, CT 06443-2462
Mailing address
80 Randi Dr
Madison, CT 06443-2462
Phone (203) 444-1227
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001182765 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 018276 | CT | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537833600000",
"number": "1629040886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 RANDI DR",
"city": "MADISON",
"state": "CT",
"postal_code": "064432462",
"telephone_number": "203-444-1227",
"fax_number": "203-444-1227"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 RANDI DR",
"city": "MADISON",
"state": "CT",
"postal_code": "064432462",
"telephone_number": "203-444-1227",
"fax_number": "203-444-1227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREENE",
"first_name": "DONALD",
"middle_name": "RICHARD",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-02",
"last_updated": "2018-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "CT",
"license": "018276",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001182765",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Madison, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.