Healthcare Provider Details

I. General information

NPI: 1811043664
Provider Name (Legal Business Name): DARIN L. GREEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FOREST AVE
DAYTON OH
45405-4500
US

IV. Provider business mailing address

300 FOREST AVE
DAYTON OH
45405-4500
US

V. Phone/Fax

Practice location:
  • Phone: 937-222-2096
  • Fax: 937-222-2946
Mailing address:
  • Phone: 937-222-2096
  • Fax: 937-222-2946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number34005569
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: