1639139942 NPI number — REBECCA S GREEN M.D.

Table of content: REBECCA S GREEN M.D. (NPI 1639139942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639139942 NPI number — REBECCA S GREEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREEN
Provider First Name:
REBECCA
Provider Middle Name:
S
Provider Name Prefix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639139942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 131
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03060-2921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-882-0555
Provider Business Mailing Address Fax Number:
603-882-0360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 131
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03060-2921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-882-0555
Provider Business Practice Location Address Fax Number:
603-882-0360
Provider Enumeration Date:
03/23/2006

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: 207V00000X , with the licence number:  5782 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207VE0102X , with the licence number: 5782 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: E17072 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30203933 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: RE0579 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 005782 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0104789Y0NH02 . This is a "ANTHEM BCBS NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 074575 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3311 . This is a "HEALTHSOURCE NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 3406995 . This is a "AETNA HEALTHCARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 782998 . This is a "MVP HEALTH PLAN" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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