Healthcare Provider Details

I. General information

NPI: 1194942151
Provider Name (Legal Business Name): CLAYTON BARON GREEN M.D.,PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 NORTH ST STE 100
CANANDAIGUA NY
14424-1075
US

IV. Provider business mailing address

15 W 27TH ST FL 11
NEW YORK NY
10001-7711
US

V. Phone/Fax

Practice location:
  • Phone: 888-344-5776
  • Fax: 999-999-9999
Mailing address:
  • Phone: 212-283-3000
  • Fax: 646-665-3604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number303395
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: