Individual
COREY EDWARD GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
40 SHAE AVE STE A, CHAPMANVILLE, WV 25508-9805
(304) 310-2261
(304) 310-2262
Mailing address
40 SHAE AVE STE A, CHAPMANVILLE, WV 25508-9805
(304) 310-2261
(304) 310-2262
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
679
WV
363AM0700X
Medical Physician Assistant
01532
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174828867
—
WV
05
—
3810020048
—
WV
Enumeration date
01/11/2011
Last updated
03/16/2022
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