Healthcare Provider Details

I. General information

NPI: 1477686905
Provider Name (Legal Business Name): RAYMOND HOWARD GREEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 OGLETOWN STANTON ROAD MEDICAL ARTS PAVILION 2, SUITE 3301
NEWARK DE
19713-2067
US

IV. Provider business mailing address

4735 OGLETOWN STANTON RD MAP 2, SUITE 3301
NEWARK DE
19713-2072
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-4370
  • Fax: 856-342-2817
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC7-0002936
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMB08839000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberC2-0011822
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: