Healthcare Provider Details

I. General information

NPI: 1750476826
Provider Name (Legal Business Name): EMILY ANN GREEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS EMILY ANN PERMAN

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 N WIGET LN STE 250
WALNUT CREEK CA
94598-2454
US

IV. Provider business mailing address

370 N WIGET LN STE 250
WALNUT CREEK CA
94598-2454
US

V. Phone/Fax

Practice location:
  • Phone: 925-278-7592
  • Fax:
Mailing address:
  • Phone: 925-278-7592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA114053
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2005015819
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: