1487766952 NPI number — DR. LINDA DIANE GREEN M.D.

Table of content: (NPI 1518985951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487766952 NPI number — DR. LINDA DIANE GREEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREEN
Provider First Name:
LINDA
Provider Middle Name:
DIANE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREEN
Provider Other First Name:
LINDA
Provider Other Middle Name:
D.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1487766952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 W CHESTER PIKE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
HAVERTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19083-4400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-446-4844
Provider Business Mailing Address Fax Number:
610-446-3901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 W CHESTER PIKE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
HAVERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19083-4439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-446-4844
Provider Business Practice Location Address Fax Number:
610-446-3901
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  MD020354E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0201X , with the licence number: MD020354E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 23-2571967 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0036284000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232571967 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232571967 . This is a "GUARDIAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4577294 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: A92498 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5648713 . This is a "CIGNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30102 . This is a "KEYSTONE MERCY HEALTH PLA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 192498 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232571967 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 000844653 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 232571967 . This is a "BENEFIT CONCEPTS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 232571967 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 787324 . This is a "FIRST HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com