Healthcare Provider Details

I. General information

NPI: 1174435572
Provider Name (Legal Business Name): MARY E GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 BUCKEYE VALLEY RD NE
SOMERSET OH
43783-9636
US

IV. Provider business mailing address

8600 BUCKEYE VALLEY RD NE
SOMERSET OH
43783-9636
US

V. Phone/Fax

Practice location:
  • Phone: 740-605-9186
  • Fax:
Mailing address:
  • Phone: 740-605-9186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: